1
|
Flentje A, Sunder G, Ceja A, Lisha NE, Neilands TB, Aouizerat BE, Lubensky ME, Capriotti MR, Dastur Z, Lunn MR, Obedin-Maliver J. Cannabis use trajectories over time in relation to minority stress and gender among sexual and gender minority people. Addict Behav 2024; 157:108079. [PMID: 38878644 DOI: 10.1016/j.addbeh.2024.108079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 05/20/2024] [Accepted: 06/05/2024] [Indexed: 07/28/2024]
Abstract
Substance use disparities among sexual and gender minority (SGM) people are attributed to minority stress, but few studies have examined minority stress and cannabis use over time or investigated differences in cannabis use trajectories by less-studied gender subgroups. We examined if longitudinal cannabis use trajectories are related to baseline minority stressors and if gender differences persisted after accounting for minority stress. Cannabis use risk was measured annually over four years (2017-2021) within a longitudinal cohort study of SGM adults in the United States (N = 11,813). Discrimination and victimization, internalized stigma, disclosure and concealment, and safety and acceptance comprised minority stress (n = 5,673). Latent class growth curve mixture models identified five cannabis use trajectories: 'low or no risk', 'low moderate risk', 'high moderate risk', 'steep risk increase', and 'highest risk'. Participants who reported past-year discrimination and/or victimization at baseline had greater odds of membership in any cannabis risk category compared to the 'low risk' category (odds ratios [OR] 1.17-1.33). Internalized stigma was related to 'high moderate' and 'highest risk' cannabis use (ORs 1.27-1.38). After accounting for minority stress, compared to cisgender men, gender expansive people and transgender men had higher odds of 'low moderate risk' (ORs 1.61, 1.67) or 'high moderate risk' (ORs 2.09, 1.99), and transgender men had higher odds of 'highest risk' (OR 2.36) cannabis use. This study indicates minority stress is related to prospective cannabis use risk trajectories among SGM people, and transgender men and gender expansive people have greater odds of trajectories reflecting cannabis use risk.
Collapse
Affiliation(s)
- Annesa Flentje
- Community Health Systems, School of Nursing, University of California, San Francisco, CA, United States; Alliance Health Project, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, San Francisco, CA, United States; The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, United States.
| | - Gowri Sunder
- Community Health Systems, School of Nursing, University of California, San Francisco, CA, United States; The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, United States
| | - Alexis Ceja
- Community Health Systems, School of Nursing, University of California, San Francisco, CA, United States; The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, United States
| | - Nadra E Lisha
- Center for Tobacco Control and Research and Education, University of California, San Francisco, CA, United States; Division of Prevention Science, Department of Medicine, University of California, San Francisco, CA, United States
| | - Torsten B Neilands
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, CA, United States
| | - Bradley E Aouizerat
- College of Dentistry, Translational Research Center, New York University, New York, NY, United States; Rory Meyers College of Nursing, New York University, New York, NY, United States
| | - Micah E Lubensky
- Community Health Systems, School of Nursing, University of California, San Francisco, CA, United States; The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, United States
| | - Matthew R Capriotti
- Department of Psychology, College of Social Sciences, San José State University, San José, CA, United States
| | - Zubin Dastur
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, United States; Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, United States
| | - Mitchell R Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, United States; Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States; Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, United States
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, United States; Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, United States; Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, United States
| |
Collapse
|
2
|
Real AG, Russell ST. Outness, Acceptance, and Victimization: A Longitudinal Study of Depressive Symptoms and Suicidality of Lesbian, Gay, and Bisexual and Transgender and Gender Diverse Youth. J Adolesc Health 2024:S1054-139X(24)00400-2. [PMID: 39352356 DOI: 10.1016/j.jadohealth.2024.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 07/30/2024] [Accepted: 08/09/2024] [Indexed: 10/03/2024]
Abstract
PURPOSE LGBTQ+ youth are at higher risk for poorer mental health. Studies are typically cross-sectional and categorize cisgender lesbian, gay, and bisexual (LGB) and transgender and gender diverse (TGD) youth as a combined group (i.e., LGBTQ+). There is a need for longitudinal studies that examine differences between LGB and TGD youth for a better understanding of their mental health needs. METHODS Data come from a 4-wave longitudinal community-based study collected between 2011 and 2015. Hierarchical Linear Models examined trajectories of depressive symptoms and suicidality, comparing LGB and TGD youth. Between-person and within-person associations were examined, accounting for cumulative experiences of victimization, outness to family, and family acceptance in association with depressive symptoms and suicidality. RESULTS The study included a diverse sample of 543 LGB and 118 TGD youth. Although TGD youth had, overall, higher levels of depression and suicidality, both LGB and TGD youth experienced improvement in mental health. Youth who were more out and accepted in family were less depressed and suicidal than youth who were less out and accepted in family. Within individuals, when youth become more out and accepted in family, they concurrently reported less depressive symptoms. The accumulation of victimization experiences was associated with higher levels of depression and suicidality, and more depression for youth across time. DISCUSSION TGD youth face higher stigmatization than LGB youth, contributing to poorer mental health and disparities. Findings suggest that both LGB and TGD youth develop resilience despite victimization, and many find support within their families to cope with stigma.
Collapse
Affiliation(s)
- André Gonzales Real
- Department of Human Development and Family Sciences, The University of Texas at Austin, Austin, Texas.
| | - Stephen T Russell
- Department of Human Development and Family Sciences, The University of Texas at Austin, Austin, Texas
| |
Collapse
|
3
|
Mereish EH. Oppression-Based Stress and Alcohol Inequities Among Sexual and Gender Minority People: An Intersectional Multilevel Framework. Alcohol Res 2024; 44:05. [PMID: 39246430 PMCID: PMC11379061 DOI: 10.35946/arcr.v44.1.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2024] Open
Abstract
PURPOSE Sexual and gender minority (SGM) people are at heightened risk for alcohol use, hazardous drinking, and alcohol use disorder compared to heterosexual and cisgender individuals. This paper: (a) presents an oppression framework that integrates intersectionality, stress, stigma, and addiction-based theories to examine the complex and nuanced ways oppression-based stress (e.g., minority stress) leads to sexual orientation and gender identity inequities in alcohol use; (b) conducts a narrative review that summarizes recent and novel advancements in the literature on the impact of oppression-based stressors on alcohol use outcomes across structural, interpersonal, and intrapersonal domains among SGM people; and (c) provides future research and intervention directions for the alcohol field. SEARCH METHODS A select review of the literature was conducted on July 10, 2023, using multiple electronic databases (i.e., PsycInfo, PubMed, Web of Science) and focusing on studies that had examined the associations between oppression-based stressors and alcohol use outcomes across structural, interpersonal, and intrapersonal levels. Search terms focused on alcohol consumption; SGM people, particularly SGM people of color; and oppression-based stress. Cross-sectional studies that focused on heterosexism-based and anti-bisexual oppression-based stressors at the interpersonal or intrapersonal levels and alcohol use outcomes were excluded as they have been included in prior reviews of the literature. SEARCH RESULTS The initial and combined search across the databases resulted in 3,205 articles. Of those, the narrative review included 50 peer-reviewed articles that focused on the following four areas of the literature on the associations between oppression-based stressors and alcohol use outcomes: (1) experimental, longitudinal, and experience sampling studies of heterosexism- and anti-bisexual oppression-based stressors (22 articles); (2) any studies of cissexism-based stressors (12 articles); (3) any studies of intersectional oppression among SGM people of color (seven articles, one article overlapped with the first category and another overlapped with the fourth category); and (4) any studies of structural oppression (11 articles). DISCUSSION AND CONCLUSIONS Results of this narrative review indicate that mounting evidence implicates oppression-based stress in inequities in alcohol use, hazardous drinking, and alcohol use disorder in SGM populations. This reflects SGM people's embodiment of oppression and injustice at the structural, interpersonal, and intrapersonal levels. Given some inconsistent and mixed patterns of findings, future research needs greater specificity in drinking inclusion criteria, robust and well-validated measures, more attention to culturally and developmentally relevant moderating and mediating mechanisms across the lifespan, application of sophisticated methodologies, and integration of intersectional and addiction frameworks.
Collapse
Affiliation(s)
- Ethan H Mereish
- Lavender Lab, Department of Psychology, University of Maryland, College Park, Maryland
| |
Collapse
|
4
|
Evans-Polce RJ, Kcomt L, Veliz P, Boyd CJ, McCabe SE. Associations of sexual identity change and identity-attraction discordance with symptomatic alcohol and other drug use. Soc Psychiatry Psychiatr Epidemiol 2024; 59:1389-1399. [PMID: 38095678 PMCID: PMC11176265 DOI: 10.1007/s00127-023-02600-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 11/20/2023] [Indexed: 06/15/2024]
Abstract
PURPOSE National studies examining alcohol and other drug use by sexual orientation have been primarily cross-sectional. Understanding changes in sexual orientation over time may further elucidate the mechanisms behind sexual orientation differences in alcohol and other drug use. This national longitudinal study examines changes in sexual orientation across four waves (2013-2019), and the associations with symptomatic alcohol and other drug use. METHODS Data from Waves 1 through 5 of the Population Assessment of Tobacco and Health (PATH) study were used to examine associations of sexual identity change/stability and sexual identity-attraction discordance/concordance from baseline to follow-up with symptomatic substance use at follow-up. We examined four outcomes: any symptomatic substance use, symptomatic alcohol use, symptomatic other drug use, and symptomatic alcohol + other drug use. Mixed effects logistic regression models were used and all analyses were weighted and stratified by sex. RESULTS In models adjusting for potential confounders, greater likelihood of symptomatic alcohol and other drug use outcomes was found among males and females experiencing a change from a heterosexual to sexual minority identity and among females with new or consistent sexual identity-attraction discordance. CONCLUSION These findings highlight important sex differences and suggest that the period of transitioning to a sexual minority identity is a particularly vulnerable period for symptomatic alcohol and other drug use. For females, incongruent sexual identity and attraction is also a risk factor. Interventions that assist individuals during this transitional period and during a time when identity and attraction are incongruent, may reduce symptomatic substance use during this period.
Collapse
Affiliation(s)
- Rebecca J Evans-Polce
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 N. Ingalls St, Ann Arbor, MI, 48108, USA.
| | - Luisa Kcomt
- School of Social Work, Wayne State University, Detroit, MI, USA
| | - Philip Veliz
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 N. Ingalls St, Ann Arbor, MI, 48108, USA
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Carol J Boyd
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 N. Ingalls St, Ann Arbor, MI, 48108, USA
- Institute for Research On Women and Gender, University of Michigan, Ann Arbor, MI, USA
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Sean Esteban McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 N. Ingalls St, Ann Arbor, MI, 48108, USA
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
- Institute for Research On Women and Gender, University of Michigan, Ann Arbor, MI, USA
- Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI, USA
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
5
|
Morgan E, Mallory A, Albright N, Dyar C. Alcohol and inflammation: Examining differences at the intersection of sexual identity and race/ethnicity. Alcohol 2024; 118:1-7. [PMID: 37952785 PMCID: PMC11090082 DOI: 10.1016/j.alcohol.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 11/01/2023] [Accepted: 11/09/2023] [Indexed: 11/14/2023]
Abstract
Sexual minorities (SMs; e.g., lesbian, gay, bisexual, and other non-heterosexual individuals) are more likely to be current alcohol drinkers than their heterosexual peers while separately experiencing elevated inflammation. Yet, little research has assessed the association between alcohol use and inflammation among subgroups of SMs, let alone potential differences among people with multiple marginal identities (e.g., race/ethnicity and sexual identity). Data came from the National Health and Nutrition Survey 2015-2016. Survey-weighted multivariable linear regression analysis was used to assess the relationship between alcohol use categories, heavy episodic drinking, and log-CRP (C-reactive protein). Models were stratified by sexual identity to determine whether associations between alcohol use and inflammation or between race/ethnicity and inflammation differed by sexual identity. Among 3220 participants, 1000 (36.8%) reported light alcohol use, 870 (32.0%) reported moderate use, and 483 (17.8%) reported heavy use. Mean raw CRP was 4.1 mg/L (SD = 8.1). The association between race/ethnicity and CRP differed in stratified relative to non-stratified models with key differences in CRP among individuals with multiple marginalized identities. We also observed that while the "classic" J-shaped relationship between alcohol use and systemic inflammation persists among heterosexuals in this sample, it does not hold among subgroups of sexual minorities. In particular, bisexuals who report heavy alcohol use, compared to non-users, experience significantly elevated CRP. Finally, we did not observe any association between heavy episodic drinking and CRP among subgroups of sexual minorities. Future studies assessing alcohol and biomarker data need to strive to include subgroups of sexual minorities and people with multiple marginal identities to better target behavioral and biomedical interventions aimed at reducing health disparities.
Collapse
Affiliation(s)
- Ethan Morgan
- College of Nursing, The Ohio State University, Columbus, OH, United States; College of Public Health, The Ohio State University, Columbus, OH, United States.
| | - Allen Mallory
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, Columbus, OH, United States
| | - Nathaniel Albright
- College of Nursing, The Ohio State University, Columbus, OH, United States
| | - Christina Dyar
- College of Nursing, The Ohio State University, Columbus, OH, United States
| |
Collapse
|
6
|
Operario D, King W, Gamarel K, Iwamoto M, Tan S, Nemoto T. Stigma and Substance Use Among Transgender and Nonbinary Young Adults: Results from the Phoenix Study. Transgend Health 2024; 9:317-325. [PMID: 39385956 PMCID: PMC11456760 DOI: 10.1089/trgh.2022.0144] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2024] Open
Abstract
Purpose The purpose of this research study was to describe and compare the prevalence of substance use behaviors in a sample of transgender and nonbinary young adults by gender subgroup (transgender men, transgender women, nonbinary people), and to examine relationships between substance use behaviors, racism, and antitransgender stigma. Methods This was an analysis of a cross-sectional sample of 215 transgender and nonbinary young adults recruited from the San Francisco Bay area between January 2019 and July 2021. We used multivariable regression models to examine associations between self-reported experiences of antitransgender stigma, racism, and substance use behaviors. Results Approximately half of the total sample reported recent heavy episodic drinking (52.8%) and club drug use (50.5%); 19.2% reported daily tobacco use, and 35.7% reported daily marijuana use. There were no gender differences in substance use behaviors. Antitransgender stigma was associated with daily marijuana use, heavy episodic drinking, and club drug use (cocaine, amphetamines, hallucinogens). Black/African American participants were more likely to report daily tobacco use and recent heavy episodic drinking than White participants, and multiracial/multiethnic participants reported greater levels of daily tobacco use compared with White participants. In addition to these main effects, a significant interaction between antitransgender stigma and racism on daily marijuana was found, suggesting risk exacerbation due to intersecting stigmas for participants of color. Conclusion Findings demonstrate a need for prevention and treatment interventions addressing linkages between antitransgender stigma, racism, and substance use behaviors among transgender and nonbinary young adults.
Collapse
Affiliation(s)
- Don Operario
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Wesley King
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Kristi Gamarel
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Sandy Tan
- Public Health Institute, Oakland, California, USA
| | - Tooru Nemoto
- Public Health Institute, Oakland, California, USA
| |
Collapse
|
7
|
Botor NJB, Tuliao AP. Measuring Propensity to Perpetrate Microaggressions Toward LGBTQ Individuals: Sexual Orientation Microaggression Scale (SOMS-P) and Gender Identity Microaggression Scale (GIMS-P) Perpetration Version. JOURNAL OF HOMOSEXUALITY 2024:1-27. [PMID: 39046349 DOI: 10.1080/00918369.2024.2381525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
This study is an initial psychometric evaluation of the Sexual Orientation Microaggression Perpetration Scale (SOMS-P) and Gender Identity Microaggression Perpetration Scale (GIMS-P). Using data from 2,059 undergraduate students (Mage = 21.37, SD = 4.98; Range 18-68; 78.6% assigned female at birth, 13.3% self-identified as sexual minority person), item factor analysis for binary indicators and model comparisons indicated that a correlated four- and five-factor solution for the SOMS-P and GIMS-P, respectively, outperformed a one-factor and higher-order solutions. SOMS-P and GIMS-P scores were positively associated with self-reports of bullying, violence perpetration, and hostile attitudes toward individuals who self-identify as sexual or gender minorities. They were negatively associated with attitudes supportive of sexual or gender minority persons. Reliability of .80 and higher was observed only for theta values between + 0.40 to + 2.60 SD. The psychometric evaluation showed that, while there remain to be opportunities to examine their validity across diverse contexts, SOMS-P and GIMS-P are sound measures of the propensity for SOGI microaggression.
Collapse
Affiliation(s)
- Nephtaly Joel B Botor
- Center for Addiction Recovery Research, Community, Family and Addiction Science Department, College of Human Sciences, Texas Tech University, Lubbock, TX, USA
| | - Antover P Tuliao
- Center for Addiction Recovery Research, Community, Family and Addiction Science Department, College of Human Sciences, Texas Tech University, Lubbock, TX, USA
| |
Collapse
|
8
|
Ehlke SJ, Fitzer SA, Stamates AL, Kelley ML. Distal and Proximal Minority Stressors on Patterns of Tobacco and Cannabis Use Among Young Bisexual Women. SUBSTANCE USE & ADDICTION JOURNAL 2024; 45:390-396. [PMID: 38258836 PMCID: PMC11209863 DOI: 10.1177/29767342231222246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
BACKGROUND Bisexual women have high rates of tobacco and cannabis use, but few studies have examined co-use behavior in this population. Although the role of distal minority stressors (eg, discrimination) on substance use has been examined, fewer studies have examined proximal minority stressors (eg, negative sexual identity self-schemas). The current study was a secondary data analysis that examined patterns of tobacco and cannabis use, and the role of distal (instability of bisexuality, sexual irresponsibility of bisexual people, and hostility toward bisexual people) and proximal (illegitimacy of bisexuality, anticipated binegativity, internalized binegativity, and identity affirmation) bisexual-specific minority stressors among bisexual women. METHODS Participants were 224 young (aged 18-30 years old) self-identified bisexual women who reported on their past 30-day tobacco and cannabis use and completed measures of distal and proximal bisexual-specific minority stressors. Participants were categorized into one of 4 patterns: no use, tobacco use only, cannabis use only, and tobacco and cannabis co-use. RESULTS The most common pattern of past 30-day use was tobacco and cannabis co-use (39.1%). Results from a multinomial logistic regression revealed that bisexual women who reported higher illegitimacy of bisexuality, a proximal minority stressor, were significantly more likely to engage in tobacco and cannabis co-use, relative to no use. DISCUSSION Bisexual women have particularly high rates of substance use, with tobacco and cannabis co-use as the most common pattern. Incorporating the role of proximal minority stressors, and specifically, beliefs about the legitimacy of bisexuality, may be an important target of substance use interventions for bisexual women.
Collapse
Affiliation(s)
- Sarah J. Ehlke
- Department of Psychology, Old Dominion University, Norfolk, VA, USA
- Virginia Consortium Program in Clinical Psychology, Norfolk, VA, USA
| | | | - Amy L. Stamates
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
| | - Michelle L. Kelley
- Department of Psychology, Old Dominion University, Norfolk, VA, USA
- Virginia Consortium Program in Clinical Psychology, Norfolk, VA, USA
| |
Collapse
|
9
|
Metheny N, Tran NK, Scott D, Dastur Z, Lubensky ME, Lunn MR, Obedin-Maliver J, Flentje A. Intimate partner violence is related to future alcohol use among a nationwide sample of LGBTQIA+ people: Results from The PRIDE Study. Drug Alcohol Depend 2024; 260:111342. [PMID: 38820909 DOI: 10.1016/j.drugalcdep.2024.111342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 04/09/2024] [Accepted: 05/14/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND Lesbian, gay, bisexual, transgender, queer, intersex, aromantic and asexual (LGBTQIA+) communities in the United States experience higher rates of alcohol use than the general population. While experiencing intimate partner violence (IPV) is thought to lead to increased alcohol use in LGBTQIA+ people, little research has investigated the temporal relationship between IPV and alcohol use in this population. METHODS Data from two annual questionnaires of The Population Research in Identity and Disparities for Equality Study (The PRIDE Study) longitudinal cohort (n=3,783) were included. Overall IPV and three sub-types (physical, sexual, and emotional) - measured in 2021 using the extended Hurt, Insult, Threaten, Scream (E-HITS) screening tool - was examined as a predictor of Alcohol Use Disorders Identification Test (AUDIT) score in 2022 using multivariable linear regression to assess linear and quadratic associations. Models were adjusted for sociodemographic characteristics and history of alcohol use. RESULTS One-quarter (24.7%) of respondents reported experiencing past-year IPV in 2021. The mean AUDIT score in 2022 was 3.52 (SD = 4.13). In adjusted models, both linear (B: 0.26, 95% CI: 0.14, 0.38) and quadratic (B: -0.03, 95% CI: -0.04, -0.01) terms for overall IPV were significantly associated with next-year AUDIT score. These patterns were mirrored in each IPV sub-type, were not attenuated when accounting for relationship characteristics, and were heterogeneous across gender identity groups. CONCLUSIONS These results provide evidence of a temporal relationship between IPV and alcohol use in LGBTQIA+ communities, suggesting that efforts to prevent and mitigate IPV may help reduce alcohol use disparities in this population.
Collapse
Affiliation(s)
- Nicholas Metheny
- Nell Hodgson Woodruff School of Nursing Emory University, Atlanta, GA, USA.
| | - Nguyen Khai Tran
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, CA, USA; Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Dalton Scott
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| | - Zubin Dastur
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, CA, USA; Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Micah E Lubensky
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, CA, USA; Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA, USA
| | - Mitchell R Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, CA, USA; Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA; Department of Epidemiology and Public Health, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, CA, USA; Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA; Department of Epidemiology and Public Health, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Annesa Flentje
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, CA, USA; Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA, USA; Department of Psychiatry, School of Medicine, University of California, San Francisco, CA, USA
| |
Collapse
|
10
|
DeSon JJ, Andover MS. Microaggressions Toward Sexual and Gender Minority Emerging Adults: An Updated Systematic Review of Psychological Correlates and Outcomes and the Role of Intersectionality. LGBT Health 2024; 11:249-268. [PMID: 37906109 DOI: 10.1089/lgbt.2023.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023] Open
Abstract
Purpose: Quantitative data on the psychological effects of microaggressions toward sexual and gender minority individuals have grown substantially. Sexual orientation-based and transgender and gender-diverse (trans+) identity-based microaggressions have been thematically identified in prior research. In addition, combined lesbian, gay, bisexual, transgender and gender-diverse, queer/questioning, and other non-heterosexual (LGBTQ) microaggressions can be examined intersectionally with other marginalized identities. This systematic review synthesizes research on the relationships among these microaggressions and psychological correlates and outcomes. Methods: Forty-five quantitative studies examining sexual orientation-, trans+ identity-, or intersectional identity-based microaggressions and various psychological outcomes were identified from systematic searches of PsycINFO, PsycARTICLES, MEDLINE, and PubMed databases. Data regarding microaggressions were extracted, synthesized, and grouped by mental health outcome or correlate. Results: Sexual orientation-based microaggressions were risk factors for depression, anxiety, and internalized stigma and were positively associated with psychological distress, traumatic stress symptoms, alcohol use and abuse, cannabis use and problems, suicidal ideation, and suicide attempt. Trans+ identity-based microaggressions were positively associated with depression, suicide attempt, and cannabis use. LGBTQ intersectional identity-based microaggressions concerning race/ethnicity were associated with depression, anxiety, and suicidal ideation. Research on other intersectional identity-based microaggressions is scarce. Conclusion: These findings emphasize the psychological harm inflicted by various microaggressions on LGBTQ late adolescents and early adults. Future work should focus on microaggressions toward individuals with trans+ and intersectional identities and protective factors for these experiences. This review also highlights the distinct need for community-based research on implementing microintervention strategies in family, school, and work environments to mitigate the harmful effects of these microaggressions.
Collapse
Affiliation(s)
- Joshua J DeSon
- Department of Psychology, Fordham University, Bronx, New York, USA
| | | |
Collapse
|
11
|
Threeton EM, Morris PE, Buckner JD. Sexual orientation-based microaggressions and cannabis use outcomes among sexual minority individuals: The impact of negative affect and coping-motivated cannabis use. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 160:209293. [PMID: 38272122 PMCID: PMC11060912 DOI: 10.1016/j.josat.2024.209293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/02/2023] [Accepted: 01/11/2024] [Indexed: 01/27/2024]
Abstract
INTRODUCTION Sexual minority individuals report significantly more cannabis use and problems than their heterosexual peers, possibly due to their frequent experiences with sexual orientation-based microaggressions. As a result, sexual minority individuals may turn to cannabis use to cope with the negative affect associated with these experiences. No known studies have tested this hypothesis; therefore, the current study tested if sexual orientation microaggressions are positively associated with negative affect (anxiety and depression), cannabis coping motives, and cannabis-related outcomes (frequency, problems); if coping motives are positively associated with cannabis-related outcomes; and if negative affect and cannabis use to cope with negative affect serially mediate the relation between sexual orientation microaggressions and cannabis-related outcomes. METHODS Sexual minority undergraduate students who reported cannabis use in the past three months (N = 328; 71.3 % cis-female) completed an online survey. RESULTS Microaggressions were significantly positively correlated with anxiety, depression, coping-motivated cannabis use, cannabis-related problems, non-sexual orientation-related stress, and overt sexual orientation-based discrimination. Additionally, after controlling for non-sexual orientation-related stress and overt sexual orientation-based discrimination, microaggressions were indirectly positively related to cannabis use frequency and problems via the sequential effects of negative affect and coping motives. This relation remained significant when examining negative affect specific to sexual orientation microaggressions and cannabis use to cope with this microaggressions-specific negative affect. CONCLUSIONS Results highlight the adverse impact of sexual orientation microaggressions in terms of negative affect and negative cannabis-related outcomes.
Collapse
Affiliation(s)
- Evan M Threeton
- Louisiana State University, Department of Psychology, 236 Audubon Hall, Baton Rouge, LA 70803, USA
| | - Paige E Morris
- Louisiana State University, Department of Psychology, 236 Audubon Hall, Baton Rouge, LA 70803, USA
| | - Julia D Buckner
- Louisiana State University, Department of Psychology, 236 Audubon Hall, Baton Rouge, LA 70803, USA.
| |
Collapse
|
12
|
Kałwak W, Weziak-Bialowolska D, Wendołowska A, Bonarska K, Sitnik-Warchulska K, Bańbura A, Czyżowska D, Gruszka A, Opoczyńska-Morasiewicz M, Izydorczyk B. Young adults from disadvantaged groups experience more stress and deterioration in mental health associated with polycrisis. Sci Rep 2024; 14:8757. [PMID: 38627525 PMCID: PMC11021532 DOI: 10.1038/s41598-024-59325-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 04/09/2024] [Indexed: 04/19/2024] Open
Abstract
The recent polycrisis (COVID-19, Ukraine war, climate change, economic crisis) has been associated with mental health through cumulative stress, with young people being particularly vulnerable. We surveyed 403 college students from Poland to examine their psychological responses to the experienced crises. The results showed that polycrisis was associated with worse mental health of college students from disadvantaged groups (based on gender, sexual orientation, and financial situation) compared to other college students, in four areas: sense of proximity to the crises, stress caused by the crises, sense of responsibility for mitigating the crises, and experiencing everyday moral dilemmas regarding the crises. These young adults also suffered more in terms of negative affectivity, depressive symptoms, and subjective physical and mental health. Our findings suggest that when discussing public mental health perspectives, it is important to consider consequences of cumulative stress and its greater impact on young people from disadvantaged groups.
Collapse
Affiliation(s)
- Weronika Kałwak
- Institute of Psychology, Faculty of Philosophy, Jagiellonian University, ul. Romana Ingardena 6, 30-060, Kraków, Poland.
| | - Dorota Weziak-Bialowolska
- Department of Quantitative Methods and Information Technology, Kozminski University, ul. Jagiellonska 57/59, 03-301, Warsaw, Poland
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, 12 Arrow St, Cambridge, MA, 02138, USA
| | - Anna Wendołowska
- Institute of Psychology, Faculty of Philosophy, Jagiellonian University, ul. Romana Ingardena 6, 30-060, Kraków, Poland
| | - Karolina Bonarska
- Institute of Psychology, Faculty of Philosophy, Jagiellonian University, ul. Romana Ingardena 6, 30-060, Kraków, Poland
| | - Katarzyna Sitnik-Warchulska
- Institute of Applied Psychology, Faculty of Management and Social Communication, Jagiellonian University, ul. Prof. Stefana Łojasiewicza 4, 30-348, Kraków, Poland
| | - Anna Bańbura
- Institute of Psychology, Faculty of Philosophy, Jagiellonian University, ul. Romana Ingardena 6, 30-060, Kraków, Poland
| | - Dorota Czyżowska
- Institute of Psychology, Faculty of Philosophy, Jagiellonian University, ul. Romana Ingardena 6, 30-060, Kraków, Poland
| | - Aleksandra Gruszka
- Institute of Psychology, Faculty of Philosophy, Jagiellonian University, ul. Romana Ingardena 6, 30-060, Kraków, Poland
| | | | - Bernadetta Izydorczyk
- Institute of Psychology, Faculty of Philosophy, Jagiellonian University, ul. Romana Ingardena 6, 30-060, Kraków, Poland
| |
Collapse
|
13
|
Shrader CH, Salerno JP, Lee JY, Johnson AL, Algarin AB. Mental health impact of multiple sexually minoritized and gender expansive stressors among LGBTQ+ young adults: a latent class analysis. Epidemiol Psychiatr Sci 2024; 33:e22. [PMID: 38602075 PMCID: PMC11022265 DOI: 10.1017/s2045796024000118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/18/2023] [Accepted: 02/03/2024] [Indexed: 04/12/2024] Open
Abstract
AIMS In the United States, lesbian, gay, bisexual, transgender, queer, intersex, asexual and other sexually minoritized and gender expansive (LGBTQ+) young adults are at increased risk for experiencing mental health inequities, including anxiety, depression and psychological distress-related challenges associated with their sexual and gender identities. LGBTQ+ young adults may have unique experiences of sexual and gender minority-related vulnerability because of LGBTQ+-related minority stress and stressors, such as heterosexism, family rejection, identity concealment and internalized homophobia. Identifying and understanding specific LGBTQ+-related minority stress experiences and their complex roles in contributing to mental health burden among LGBTQ+ young adults could inform public health efforts to eliminate mental health inequities experienced by LGBTQ+ young adults. Therefore, this study sought to form empirically based risk profiles (i.e., latent classes) of LGBTQ+ young adults based on their experiences with familial heterosexist experiences, LGBTQ+-related family rejection, internalized LGBTQ+-phobia and LGBTQ+ identity concealment, and then identify associations of derived classes with psychological distress. METHODS We recruited and enrolled participants using nonprobability, cross-sectional online survey data collected between May and August 2020 (N = 482). We used a three-step latent class analysis (LCA) approach to identify unique classes of response patterns to LGBTQ+-related minority stressor subscale items (i.e., familial heterosexist experiences, LGBTQ+-related family rejection, internalized LGBTQ+-phobia and LGBTQ+ identity concealment), and multinomial logistic regression to characterize the associations between the derived classes and psychological distress. RESULTS Five distinct latent classes emerged from the LCA: (1) low minority stress, (2) LGBTQ+ identity concealment, (3) family rejection, (4) moderate minority stress and (5) high minority stress. Participants who were classified in the high and moderate minority stress classes were more likely to suffer from moderate and severe psychological distress compared to those classified in the low minority stress class. Additionally, relative to those in the low minority stress class, participants who were classified in the LGBTQ+ identity concealment group were more likely to suffer from severe psychological distress. CONCLUSION Familial heterosexist experiences, LGBTQ+-related family rejection, internalized LGBTQ+-phobia and LGBTQ+ identity concealment are four constructs that have been extensively examined as predictors for mental health outcomes among LGBTQ+ persons, and our study is among the first to reveal nuanced gradients of these stressors. Additionally, we found that more severe endorsement of minority stress was associated with greater psychological distress. Given our study results and the previously established negative mental health impacts of minority stressors among LGBTQ+ young adults, findings from our study can inform research, practice, and policy reform and development that could prevent and reduce mental health inequities among LGBTQ+ young adults.
Collapse
Affiliation(s)
- C.-H. Shrader
- Department of Epidemiology, Columbia University, New York City, NY, USA
- ICAP at Columbia University, New York City, NY, USA
| | - J. P. Salerno
- School of Social Work, Columbia University, New York City, NY, USA
| | - J.-Y. Lee
- Department of Mental Health Law & Policy, University of South Florida, Tampa, FL, USA
| | - A. L. Johnson
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, USA
| | - A. B. Algarin
- Department of Nursing and Health Innovations, Arizona State University, Phoenix, AZ, USA
| |
Collapse
|
14
|
Dyar C. The cumulative effects of stigma-related stress: Chronic stigma-related stress exposure exacerbates daily associations between enacted stigma and anxious/depressed affect. Soc Sci Med 2024; 344:116604. [PMID: 38281458 PMCID: PMC10923191 DOI: 10.1016/j.socscimed.2024.116604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/12/2024] [Accepted: 01/15/2024] [Indexed: 01/30/2024]
Abstract
PURPOSE Sexual and gender minority individuals are at elevated risk for mood and anxiety disorders compared to heterosexual and cisgender individuals. Ecological momentary assessments studies have implicated experiences of enacted stigma (i.e., biased treatment) by linking these experiences with elevations in anxious and depressed affect. The current study utilizes a theory from the broader stress and affect literature to determine whether chronic enacted stigma exposure amplifies individuals' negative affective reactions to experiences of enacted stigma at the daily level. METHODS We used data from a 30-day ecological momentary assessment study with 429 sexual minority women and gender diverse sexual minorities assigned female at birth (SMWGD) living in the US in 2020-21 to determine whether concurrent and prospective event-level associations between enacted stigma, anxious/depressed affect, and perceived coping efficacy were moderated by chronic enacted stigma exposure. RESULTS Results demonstrate that individuals with moderate to high chronic stigma exposure experience larger increases in anxious/depressed affect and larger decreases in perceived coping efficacy following daily experiences of enacted stigma. Further, these effects of daily stigma on anxious/depressed affect persist for longer among individuals with high chronic stigma exposure. Interestingly, chronic stigma exposure did not moderate associations between daily general stressors (i.e., those unrelated to identity) and affect or perceived coping efficacy, suggesting that these effects are specific to stigma-related stressors. CONCLUSIONS These results help to advance our understanding of both long-term and daily effects of exposure to enacted stigma, highlighting the potentially profound cumulative effects of stigma exposure and the need to intervene in this cycle.
Collapse
Affiliation(s)
- Christina Dyar
- College of Nursing, Ohio State University, 393 Newton Hall 1585 Neil Ave Columbus, OH, 43210, USA.
| |
Collapse
|
15
|
Dyar C, Crosby S, Newcomb ME, Mustanski B, Kaysen D. Doomscrolling: Prospective associations between daily COVID news exposure, internalizing symptoms, and substance use among sexual and gender minority individuals assigned female at birth. PSYCHOLOGY OF SEXUAL ORIENTATION AND GENDER DIVERSITY 2024; 11:139-152. [PMID: 38737889 PMCID: PMC11081596 DOI: 10.1037/sgd0000585] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Cross-sectional studies have demonstrated associations between COVID news exposure, anxiety, and depression. However, longitudinal research examining the directionality of these associations is extremely limited. Further, most studies have focused on the general population and neglected sexual and gender minority individuals (SGM), a population disproportionately impacted by the pandemic. To address these limitations, the current study utilized data from a 30-day diary study of SGM assigned female at birth (N = 429). We examined concurrent and prospective associations between COVID news exposure, depressed and anxious affect, COVID distress, substance use, and motives for use. Further, we examined associations between cumulative COVID news exposure across the diary period and prospective changes in anxiety, depression, and COVID distress. When participants were exposed to more COVID news, they experienced more depressed and anxious affect, more COVID distress, less positive affect, and were more likely to use alcohol and cannabis to cope. Further, when participants were exposed to more COVID news, they experienced subsequent increases in depressed affect, decreases in positive affect, and increases in the likelihood of using cannabis to cope. Findings also provided evidence of bi-directional prospective associations between COVID news exposure and COVID distress and of a cumulative impact of COVID news exposure on anxiety, depression, and COVID distress. Findings suggest that individuals should balance the need to remain informed about the pandemic and their own mental health when considering how much COVID news to consume.
Collapse
Affiliation(s)
| | | | - Michael E. Newcomb
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University
| | - Debra Kaysen
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| |
Collapse
|
16
|
Morgan E, Dyar C, Rose K. Dissecting sexual minority subgroup differences in the association between depression, anxiety, and cognitive difficulties. PLoS One 2024; 19:e0295821. [PMID: 38170685 PMCID: PMC10763951 DOI: 10.1371/journal.pone.0295821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 11/30/2023] [Indexed: 01/05/2024] Open
Abstract
INTRODUCTION A growing body of research has demonstrated extensive mental health disparities affecting sexual minority populations, yet little research has assessed how these disparities may affect cognitive functioning among subgroups of sexual minorities. METHODS Data come from the 2021 National Health Information Survey (NHIS). Survey-weighted linear regression analyses were used to assess self-reported measures of cognition, stratified by subgroups sexual identity. In particular, we focused on the association between symptoms of depression or anxiety and each of the measures of cognition, adjusting for demographic covariates. RESULTS Among 31,994 NHIS participants in the 2021 survey, 5,658 (17.7%) reported at least some difficulty in remembering or concentrating. Basic demographic differences existed when assessing any cognitive difficulty, particularly for bisexual participants (aOR = 2.73; 95% CI: 2.07, 3.60) and participants identifying as a different identity (aOR = 4.22; 95% CI: 2.72, 6.56). Depression was significantly associated with cognitive difficulty with the largest relationship observed among gay/lesbian participants (aOR = 1.39; 95% CI: 1.29, 1.49). The association between anxiety and cognitive difficulty was smallest among bisexuals (aOR = 1.13; 95% CI: 1.08, 1.18) and relatively consistent across other subgroups: heterosexuals (aOR = 1.23; 95% CI: 1.22, 1.24), gay/lesbians (aOR = 1.27; 95% CI: 1.19, 1.36), and those with a different identity (aOR = 1.22; 95% CI: 1.10, 1.35). CONCLUSION There is a clear set of health disparities between sexual minority subgroups and heterosexuals across all cognitive difficulties. Future research should focus on developing a better understanding of differences in cognition based on sexual minority status while also working to ascertain how disparities vary among sexual minorities.
Collapse
Affiliation(s)
- Ethan Morgan
- College of Nursing, The Ohio State University, Columbus, OH, United States of America
- College of Public Health, The Ohio State University, Columbus, OH, United States of America
| | - Christina Dyar
- College of Nursing, The Ohio State University, Columbus, OH, United States of America
| | - Karen Rose
- College of Nursing, The Ohio State University, Columbus, OH, United States of America
| |
Collapse
|
17
|
Struble CA, Borodovsky JT, Habib MI, Livne O, Walsh CA, Aharonovich E, Hasin DS, Budney AJ. Evaluating age-related disparities in cannabis-related problems among LGBT+ versus non-LGBT+ adults. Addict Behav 2024; 148:107861. [PMID: 37748224 PMCID: PMC10713017 DOI: 10.1016/j.addbeh.2023.107861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 09/11/2023] [Accepted: 09/11/2023] [Indexed: 09/27/2023]
Abstract
LGBT+ adults demonstrate greater cannabis-related problems (e.g., Cannabis Use Disorder [CUD]) compared to non-LGBT+ counterparts. No study has explored age-related disparities in cannabis problems across the adult lifespan, nor have studies identified specific CUD criteria that contribute to elevated CUD among LGBT+ adults. The purpose of this study was to examine associations between LGBT+ identity and age with endorsement of CUD criteria in a sample of regular cannabis consumers. An online sample of N = 4334 (25.1% LGBT+) adults aged 18-64 residing in the U.S. completed an online survey about cannabis use behaviors and CUD diagnostic criteria. Bivariate contrasts revealed significantly greater CUD criteria endorsement among LGBT+ respondents, largely driven by differences at younger ages. However, this effect disappeared in the majority of adjusted logistic regression models. LGBT+ identity was associated with greater probability of use in larger amounts (adjOR = 2.10, 95% CI: 1.22-3.60) and use despite physical/mental health problems (adjOR = 2.51, 95% CI:1.23-5.03). No age*LGBT+ identity interactions were detected. Plotted trends depict more pronounced disparities in outcomes among LGBT+ adults under 35 years. Several potential risk and protective factors including employment, education, and reasons for use were identified. There were age-related differences in these characteristics among LGBT+ and non-LGBT+ respondents. Initial findings highlight the need for LGBT+ research examining trends in health outcomes and sociodemographic and cannabis characteristics across the lifespan. The study also provides a substantive contribution regarding specific cannabis-related problems that young LGBT+ cannabis consumers may be more likely to endorse than their non-LGBT+ counterparts.
Collapse
Affiliation(s)
- Cara A Struble
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Williamson Translational Research Building, Third Floor HB 7261, 1 Medical Center Drive, Lebanon, NH 03756, USA.
| | - Jacob T Borodovsky
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Williamson Translational Research Building, Third Floor HB 7261, 1 Medical Center Drive, Lebanon, NH 03756, USA.
| | - Mohammad I Habib
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Williamson Translational Research Building, Third Floor HB 7261, 1 Medical Center Drive, Lebanon, NH 03756, USA.
| | - Ofir Livne
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
| | - Claire A Walsh
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, USA.
| | - Efrat Aharonovich
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
| | - Deborah S Hasin
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA; Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168(th) St, New York, NY 10032, USA.
| | - Alan J Budney
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Williamson Translational Research Building, Third Floor HB 7261, 1 Medical Center Drive, Lebanon, NH 03756, USA; Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA.
| |
Collapse
|
18
|
Maglalang DD, Hu Y, Baslock D, Daus JD, Cano M, Ahluwalia JS. Recency of Cannabis Vaping in Sexual Minorities in Wave 5 of the Population Assessment of Tobacco and Health (PATH) Study. Subst Use Misuse 2023; 59:136-142. [PMID: 37750356 PMCID: PMC10842009 DOI: 10.1080/10826084.2023.2262024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
BACKGROUND Cannabis vaping is increasing in the United States. Among populations at-risk are sexual minorities (SM) who are more likely to vape cannabis compared to their heterosexual counterparts. Cannabis vaping has been associated with negative health outcomes and concomitant use of other substances with increased risk with more recent use. OBJECTIVES This study examined the association between SM identification and recency of cannabis vaping (the last occasion that a participant used their vape device with cannabis) and number of puffs (the count of puffs that the participant took during their most recent use of their vape device with cannabis) using Wave 5 of the Population Assessment of Tobacco and Health (PATH) Study. RESULTS In a weighted sample of participants who reported ever vaping cannabis (N = 5,331), 15% identified as SM, about 60% vaped cannabis in the past 3 or more days, and the mean number of puffs was 2 (SE = 0.17). Using multinomial logistic regression and zero-inflated negative binomial regression, the results showed that compared to heterosexual adults who reported not recently vaping cannabis, SM had higher probabilities of vaping cannabis in the past 3 or more days, 1-2 days, and the day of interview. CONCLUSION SM individuals were more likely to recently vape cannabis, placing them at higher risk for respiratory diseases and use of other substances. Public health researchers and practitioners need to identify reasons for cannabis vaping in this population and implement targeted public health messaging to inform SM communities of the potential health effects of cannabis vaping.
Collapse
Affiliation(s)
- Dale Dagar Maglalang
- Silver School of Social Work, New York University, New York, USA
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Yuanyuan Hu
- Silver School of Social Work, New York University, New York, USA
| | - Daniel Baslock
- Silver School of Social Work, New York University, New York, USA
| | - Jeanelle Dyan Daus
- Department of Asian American Studies, San Francisco State University, San Francisco, California, USA
| | - Manuel Cano
- School of Social Work, Arizona State University, Phoenix, Arizona, USA
| | - Jasjit S. Ahluwalia
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island, USA
- Department of Medicine, Alpert Medical School, Brown University, Providence, Rhode Island, USA
- Legoretta Cancer Center, Brown University, Providence, Rhode Island, USA
| |
Collapse
|
19
|
Komlenac N, Langmann F, Hochleitner M. Explorative Questionnaire Study About Education with Regard to the Health of Sexual Minorities at an Austrian Medical University. JOURNAL OF HOMOSEXUALITY 2023; 70:2955-2977. [PMID: 35700380 DOI: 10.1080/00918369.2022.2085937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Physicians can play a critical role in helping lesbian, gay, and bisexual-identified (LGB) individuals face minority stress. The current questionnaire study among 305 medical students (62.6% women/37.4% men; Mage = 23.4, SD = 3.2) assessed whether medical students learn about LGB-specific concepts at an Austrian medical university. Students reported that their education contained little content about LGB-specific concepts. The majority of students did not hold negative attitudes toward homosexuality and they would like a larger range of courses concerning LGB-specific topics. The barrier most strongly associated with the intention to ask future patients about their sexual orientation was the belief that sexual orientation was irrelevant for clinical practice. Future education programs on LGB-specific topics may not need to focus on reducing negative attitudes toward sexual minorities, but should contain more facts on LGB individuals' specific healthcare needs and explain to students why a patient's sexual orientation is important to healthcare.
Collapse
Affiliation(s)
- Nikola Komlenac
- Gender Medicine Unit, Medical University of Innsbruck, Innsbruck, Austria
| | - Flora Langmann
- Gender Medicine Unit, Medical University of Innsbruck, Innsbruck, Austria
| | | |
Collapse
|
20
|
Assaf RD, Javanbakht M, Gorbach PM, Cooper ZD. Cannabis Use and Sharing Practices Among Sexual Minority and Heterosexual Individuals During the COVID-19 Pandemic. LGBT Health 2023; 10:514-525. [PMID: 37252794 PMCID: PMC10552144 DOI: 10.1089/lgbt.2022.0236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
Purpose: Cannabis behaviors during the COVID-19 pandemic among sexual minority (SM) individuals in the United States remain understudied. This study assessed the prevalence and correlates of cannabis use and cannabis sharing, a potential risk for COVID-19 transmission, among SM and heterosexual-identified individuals in the United States during the COVID-19 pandemic. Methods: This cross-sectional study used data from an anonymous, US-based web survey on cannabis-related behaviors from August to September 2020. Included participants reported past-year nonmedical cannabis use. Associations between frequency of cannabis use and sharing behaviors by sexual orientation were evaluated using logistic regression analysis. Results: Overall, 1112 respondents reported past-year cannabis use; mean age 33 years (standard deviation = 9.4), 66% male identified (n = 723), and 31% SM identified adults (n = 340). Increased cannabis use during the pandemic was similar among SM (24.7%; n = 84) and heterosexual (24.9%; n = 187) respondents. Any sharing during the pandemic was 81% for SM adults (n = 237) and 73% for heterosexual adults (n = 486). In the fully adjusted models, the odds of daily/weekly cannabis use and the odds of any cannabis sharing among SM respondents were 0.56 (95% confidence interval [CI] = 0.42-0.74) and 1.60 (95% CI = 1.13-2.26), respectively, compared with heterosexual respondents. Conclusions: SM respondents were less likely to use cannabis with high frequency during the pandemic but more likely to share cannabis compared with heterosexual respondents. Sharing cannabis was high overall, which may increase COVID-19 risk. Public health messaging around sharing may be important during COVID-19 surges and respiratory pandemics especially as cannabis becomes more widely available in the United States.
Collapse
Affiliation(s)
- Ryan D. Assaf
- UCLA Center for Cannabis and Cannabinoids, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California, USA
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA
| | - Marjan Javanbakht
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA
| | - Pamina M. Gorbach
- UCLA Center for Cannabis and Cannabinoids, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California, USA
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Ziva D. Cooper
- UCLA Center for Cannabis and Cannabinoids, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, USA
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| |
Collapse
|
21
|
Rosenthal SR, Gately KA, Archibald N, Baker AB, Dawes MP, Swanberg JE. Substance Misuse among Sexual and Gender Minorities: The Role of Everyday Discrimination and Identity. Subst Use Misuse 2023; 58:1874-1882. [PMID: 37707795 DOI: 10.1080/10826084.2023.2257309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
BACKGROUND Sexual and gender minorities (SGMs) often deal with discrimination which can result in maladaptive coping like substance misuse, yet few studies have examined the association between everyday discrimination and various types of substance misuse among SGMs or whether there is heterogeneity in substance misuse or this relationship by SGM identity. METHODS Data from 1316 adult SGMs in the United States were recruited from Reddit between February and March 2022. SGM identities (sexual minorities assigned male at birth (AMAB), sexual minorities assigned female at birth (AFAB), gender minorities AMAB, gender minorities AFAB), everyday discrimination, depressive symptoms, marijuana and alcohol misuse, over-the-counter drug misuse, prescription drug misuse, and heroin use were measured, along with demographics. Multivariable logistic regressions examined relationships between everyday discrimination and each substance misuse outcome, adjusting for SGM identity, race/ethnicity, age, income, and depressive symptoms. Interaction terms between everyday discrimination and SGM identities were added to each model to test for moderation. RESULTS In fully adjusted models, with each additional unit of everyday discrimination score, there were significantly increased odds of substance misuse for all outcomes. SGM by everyday discrimination interactions was significant for alcohol misuse, over-the-counter drug misuse, and heroin use, with the association between everyday discrimination and substance misuse stronger among gender minorities. CONCLUSIONS Substance misuse varied by SGM identity. Everyday discrimination was associated with substance misuse, but there was heterogeneity in this relationship between SGM identity and substance. Substance use disorder treatment and prevention among SGMs should consider heterogeneity by SGM identity and substance.
Collapse
Affiliation(s)
- Samantha R Rosenthal
- Department of Health Science, College of Health & Wellness, Johnson & Wales UniversityProvidence, USA
- Department of Epidemiology, Brown School of Public Health, Brown University, Providence, USA
| | - Kelsey A Gately
- Department of Occupational Therapy, College of Health and Wellness, Johnson & Wales University, Providence,USA
| | - Natalya Archibald
- Department of Health Science, College of Health & Wellness, Johnson & Wales UniversityProvidence, USA
| | - Allyson B Baker
- Department of Occupational Therapy, College of Health and Wellness, Johnson & Wales University, Providence,USA
| | - Monique P Dawes
- Department of Occupational Therapy, College of Health and Wellness, Johnson & Wales University, Providence,USA
| | - Jennifer E Swanberg
- Department of Health Science, College of Health & Wellness, Johnson & Wales UniversityProvidence, USA
| |
Collapse
|
22
|
Keefe JR, Louka C, Moreno A, Spellun J, Zonana J, Milrod BL. Open Trial of Trauma-Focused Psychodynamic Psychotherapy for Posttraumatic Stress Disorder Among LGBTQ Individuals. Am J Psychother 2023; 76:115-123. [PMID: 37203147 DOI: 10.1176/appi.psychotherapy.20220037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
OBJECTIVE Lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals report higher rates of exposure to traumatic events and posttraumatic stress disorder (PTSD) compared with heterosexual and cisgender individuals. No treatment outcomes research has focused on PTSD in the LGBTQ population. Trauma-focused psychodynamic psychotherapy (TFPP) is a brief, manualized, attachment- and affect-focused psychotherapy for PTSD. TFPP explicitly incorporates broad identity-related and societal factors into its conceptualization of trauma and its consequences, which may be especially helpful for LGBTQ patients with minority stress who seek affirmative care. METHODS Fourteen LGBTQ patients with PTSD, assessed with the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), received 24 sessions of twice-weekly (12 weeks) TFPP via teletherapy provided by supervised early-career therapists inexperienced in the modality. Sessions were videotaped to monitor therapists' treatment adherence. Patients were assessed at baseline, week 5, termination (week 12), and 3 months posttreatment for PTSD symptoms (assessed with the CAPS-5) and secondary outcomes. RESULTS TFPP was well tolerated by patients, with 12 (86%) completing the intervention. CAPS-5-measured PTSD symptoms, including dissociation, significantly improved during treatment (mean decrease=-21.8, d=-1.98), and treatment gains were maintained at follow-up. Most patients experienced PTSD clinical response (N=10, 71%) or diagnostic remission (N=7, 50%). Patients generally experienced significant, concomitant improvements in complex PTSD symptoms, general anxiety, depression, and psychosocial functioning. Adherence to the intervention among therapists was high, with 93% of rated sessions meeting adherence standards. CONCLUSIONS TFPP shows promise in the treatment of PTSD among sexual and gender minority patients seeking LGBTQ-affirmative PTSD care.
Collapse
Affiliation(s)
- John R Keefe
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York City (Keefe, Milrod); Department of Psychiatry, Weill Cornell Medical College, New York City (Keefe, Moreno, Spellun, Zonana, Milrod); Department of Psychiatry, New York-Presbyterian/Weill Cornell Medical Center, New York City (Louka); Silver Hill Hospital, New Canaan, Connecticut (Zonana)
| | - Charalambia Louka
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York City (Keefe, Milrod); Department of Psychiatry, Weill Cornell Medical College, New York City (Keefe, Moreno, Spellun, Zonana, Milrod); Department of Psychiatry, New York-Presbyterian/Weill Cornell Medical Center, New York City (Louka); Silver Hill Hospital, New Canaan, Connecticut (Zonana)
| | - Andrew Moreno
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York City (Keefe, Milrod); Department of Psychiatry, Weill Cornell Medical College, New York City (Keefe, Moreno, Spellun, Zonana, Milrod); Department of Psychiatry, New York-Presbyterian/Weill Cornell Medical Center, New York City (Louka); Silver Hill Hospital, New Canaan, Connecticut (Zonana)
| | - Jessica Spellun
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York City (Keefe, Milrod); Department of Psychiatry, Weill Cornell Medical College, New York City (Keefe, Moreno, Spellun, Zonana, Milrod); Department of Psychiatry, New York-Presbyterian/Weill Cornell Medical Center, New York City (Louka); Silver Hill Hospital, New Canaan, Connecticut (Zonana)
| | - Jess Zonana
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York City (Keefe, Milrod); Department of Psychiatry, Weill Cornell Medical College, New York City (Keefe, Moreno, Spellun, Zonana, Milrod); Department of Psychiatry, New York-Presbyterian/Weill Cornell Medical Center, New York City (Louka); Silver Hill Hospital, New Canaan, Connecticut (Zonana)
| | - Barbara L Milrod
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York City (Keefe, Milrod); Department of Psychiatry, Weill Cornell Medical College, New York City (Keefe, Moreno, Spellun, Zonana, Milrod); Department of Psychiatry, New York-Presbyterian/Weill Cornell Medical Center, New York City (Louka); Silver Hill Hospital, New Canaan, Connecticut (Zonana)
| |
Collapse
|
23
|
Frances C, Garnsey C, DeMulder J. Neglected gaps in improving the health, wellbeing, and care for sexual and gender minority young people living in low- and lower-middle- income countries: a scoping review. BMC Public Health 2023; 23:1664. [PMID: 37648963 PMCID: PMC10466764 DOI: 10.1186/s12889-023-16443-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/02/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND There is a lack of reliable data on the size, characteristics, and experiences of sexual and gender minority (SGM) young people (ages 10-24) in low- and lower-middle- income countries (LMICs). This review examines the research conducted in the last thirteen years with and about SGM young people living in low-income settings and seeks to answer the question: What is known about the mental and physical health needs, safety, and wellbeing of SGM young people living in LMICs? METHODS We conducted a scoping review informed by the methodological frameworks put forth by Arksey and O'Malley and the Joanna Briggs Institute. We systematically searched two general social science databases and one topic-specific database for peer-reviewed papers, of any research design, that included SGM young people or explored attitudes toward SGM young people in LMICs. We included papers that reported on factors influencing the health and wellbeing of SGM populations, including physical and mental health, healthcare-seeking behaviors, substance use, experiences of discrimination and/or stigma, experiences of violence and abuse (emotional, physical, and/or sexual), economically motivated paid sex practices, housing or economic security, and attitudes of others toward SGM populations. RESULTS Of the 5,409 unique records identified, 79 papers drawing from data collected from 74 unique studies met the inclusion criteria. Only 50 of the 79 papers included SGM young people as participants, with just 13 focusing exclusively on SGM young people ages 10-24. The included papers were classified into three thematic groupings: attitudes toward SGM populations (n = 26), risks to health (n = 40), and experiences of stigma and discrimination (n = 13). CONCLUSION The findings indicate that the health and wellbeing of SGM young people in LMICs has been historically under-researched. While SGM young people have received more attention from researchers in recent years, the body of literature as a whole is disjointed and sparse, and often studies are about SGM young people, rather than with and for them. Our review highlights the need for more and better research, more accurate and disaggregated demographic data, and leadership and participation of SGM-led community-based organizations in the co-design of studies that focus on SGM young people.
Collapse
Affiliation(s)
| | - Camille Garnsey
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | | |
Collapse
|
24
|
Williams DY, Hall WJ, Dawes HC, Srivastava A, Radtke SR, Ramon M, Bouchard D, Chen WT, Goldbach JT. Relationships between internalized stigma and depression and suicide risk among queer youth in the United States: a systematic review and meta-analysis. Front Psychiatry 2023; 14:1205581. [PMID: 37547195 PMCID: PMC10399219 DOI: 10.3389/fpsyt.2023.1205581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/30/2023] [Indexed: 08/08/2023] Open
Abstract
Background Queer youth experience high rates of depression and suicidality. These disparities stem from stigma-based stressors, including internalized stigma (i.e., negative social views that minoritized individuals internalize about their own identity). Given the importance of this factor in understanding mental health disparities among queer youth, we completed a systematic review and meta-analysis examining the relationships between internalized stigma and outcomes of depression and suicide risk (i.e., suicidal ideation, non-suicidal self-injury, and suicidal behavior). Methods We followed the PRISMA standards. Six bibliographic databases were searched for studies in the United States from September 2008 to March 2022. Dual independent screening of search results was performed based on a priori inclusion criteria. Results A total of 22 studies were included for data extraction and review. Most studies examined general internalized homophobia, with few examining internalized biphobia or transphobia. Many studies examined depression as an outcome, few studies examined suicidal ideation or behavior, and no studies examined non-suicidal self-injury. Meta-analyses model results show the association between general internalized queer stigma and depressive symptoms ranged r = 0.19, 95% CI [0.14, 0.25] to r = 0.24, 95% CI [0.19, 0.29], the latter reflecting more uniform measures of depression. The association between internalized transphobia and depressive outcomes was small and positive (r = 0.21, 95% CI [-0.24, 0.67]). General internalized queer stigma and suicidal ideation had a very weak positive association (r = 0.07, 95% CI [-0.27, 0.41]) and an even smaller, weaker positive association with suicide attempt (r = 0.02, 95% CI [0.01, 0.03]). Conclusion Implications for clinical practice, policy, and future research are discussed.
Collapse
Affiliation(s)
| | - William J. Hall
- School of Social Work, University of North Carolina, Chapel Hill, NC, United States
| | - Hayden C. Dawes
- School of Social Work, University of North Carolina, Chapel Hill, NC, United States
| | - Ankur Srivastava
- School of Social Work, University of North Carolina, Chapel Hill, NC, United States
| | - Spenser R. Radtke
- School of Social Work, University of North Carolina, Chapel Hill, NC, United States
| | - Magdelene Ramon
- School of Social Work, University of North Carolina, Chapel Hill, NC, United States
| | - D. Bouchard
- School of Social Work, University of North Carolina, Chapel Hill, NC, United States
| | - Wan-Ting Chen
- School of Social Work, University of North Carolina, Chapel Hill, NC, United States
| | - Jeremy T. Goldbach
- Brown School of Social Work at Washington University, St. Louis, MO, United States
| |
Collapse
|
25
|
Lin SY, Schleider JL, Nelson BD, Richmond LL, Eaton NR. Gender and Racial/Ethnic Disparities in Undergraduate and Graduate Students' Mental Health and Treatment Use Amid the COVID-19 Pandemic. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:552-562. [PMID: 36802042 PMCID: PMC9937864 DOI: 10.1007/s10488-023-01256-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2023] [Indexed: 02/20/2023]
Abstract
The COVID-19 pandemic has negatively impacted numerous people?s mental health and created new barriers to services. To address the unknown effects of the pandemic on accessibility and equality issues in mental health care, this study aimed to investigate gender and racial/ethnic disparities in mental health and treatment use in undergraduate and graduate students amid the COVID-19 pandemic. The study was conducted based on a largescale online survey (N = 1,415) administered during the weeks following a pandemic-related university-wide campus closure in March 2020. We focused on the gender and racial disparities in current internalizing symptomatology and treatment use. Our results showed that in the initial period of the pandemic, students identified as cis women (p < .001), non-binary/genderqueer (p < .001), or Hispanic/Latinx (p = .002) reported higher internalizing problem severity (aggregated from depression, generalized anxiety, intolerance of uncertainty, and COVID-19-related stress symptoms) compared to their privileged counterparts. Additionally, Asian (p < .001) and multiracial students (p = .002) reported less treatment use than White students while controlling for internalizing problem severity. Further, internalizing problem severity was associated with increased treatment use only in cisgender, non-Hispanic/Latinx White students (pcis man = 0.040, pcis woman < 0.001). However, this relationship was negative in cis-gender Asian students (pcis man = 0.025, pcis woman = 0.016) and nonsignificant in other marginalized demographic groups. The findings revealed unique mental health challenges faced by different demographic groups and served as a call that specific actions to enhance mental health equity, such as continued mental health support for students with marginalized gender identities, additional COVID-related mental and practical support for Hispanic/Latinx students and promotion of mental health awareness, access, and trust in non-White, especially Asian, students are desperately needed.
Collapse
Affiliation(s)
- Sin-Ying Lin
- Department of Psychology, Stony Brook University, 100 Nicolls Road, 11794, Stony Brook, NY, USA.
| | - Jessica L Schleider
- Department of Psychology, Stony Brook University, 100 Nicolls Road, 11794, Stony Brook, NY, USA
| | - Brady D Nelson
- Department of Psychology, Stony Brook University, 100 Nicolls Road, 11794, Stony Brook, NY, USA
| | - Lauren L Richmond
- Department of Psychology, Stony Brook University, 100 Nicolls Road, 11794, Stony Brook, NY, USA
| | - Nicholas R Eaton
- Department of Psychology, Stony Brook University, 100 Nicolls Road, 11794, Stony Brook, NY, USA
| |
Collapse
|
26
|
Swann G, Bettin E, Ryan DT, Clifford A, Newcomb ME, Whitton SW, Mustanski B. The Sexual Orientation Microaggression Inventory Short Form (SOMI-SF): Validation in Three Samples of Racially/Ethnically Diverse Sexual Minority Youth. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2023; 20:589-598. [PMID: 37637938 PMCID: PMC10454520 DOI: 10.1007/s13178-022-00695-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/04/2022] [Indexed: 08/29/2023]
Abstract
Introduction The Sexual Orientation Microaggression Inventory (SOMI) has been used to measure sexual orientation-based microaggression experiences. However, at 19 items, the SOMI may be difficult to fit into survey batteries where microaggressions are not the primary predictor or the time researchers have with each participant is very limited. Methods We sought to identify an eight-item short form of the SOMI (SOMI-SF) in a sample of sexual minority (SM) youth (N = 879) and confirm the validity and reliability of the SOMI-SF by administering both versions to separate cohorts of male-assigned (N = 533) and female-assigned (N = 430) at birth SM youth. Data was collected from April 2018 to May 2020. Results We found high reliability (α > 0.80) and validity (significant association with SM victimization, depression symptoms, anxiety symptoms, and internalized stigma) in all three samples for the SOMI-SF. Conclusions For researchers looking to conserve time and limit burden, the SOMI-SF is a high quality option for measuring sexual orientation microaggressions. Policy Implications The greater ease of administering the SOMI-SF means that sexual orientation microaggressions can be measured in a greater number of contexts. With a growing literature linking these experiences to poorer health outcomes for SM populations, measuring these experiences quickly and accurately can improve our understanding of the mechanisms creating those links and impact policy necessary to alleviate them.
Collapse
Affiliation(s)
- Gregory Swann
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
- Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL
| | - Emily Bettin
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
- Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL
| | - Daniel T Ryan
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
- Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL
| | - Antonia Clifford
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
- Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL
| | - Michael E Newcomb
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
- Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL
| | - Sarah W Whitton
- Department of Psychology, University of Cincinnati, Cincinnati, OH
| | - Brian Mustanski
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
- Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL
| |
Collapse
|
27
|
Dyar C, Feinstein BA, Albright J, Newcomb ME, Whitton SW. Associations between Drinking Contexts, Minority Stress, and Problematic Alcohol Use among Sexual Minority Individuals Assigned Female at Birth. PSYCHOLOGY OF SEXUAL ORIENTATION AND GENDER DIVERSITY 2023; 10:292-303. [PMID: 37484479 PMCID: PMC10361668 DOI: 10.1037/sgd0000426] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Sexual minority individuals assigned female at birth (SM-AFAB) are at increased risk for problematic alcohol use compared to heterosexual women. Despite evidence that drinking locations and companions play an important role in problematic alcohol use among heterosexuals, few studies have examined these social contexts of alcohol use among SM-AFAB. To address this gap, the current study examined two aspects of social contexts in which SM-AFAB drink (locations and companions). We utilized two waves of data (six-months between waves) from an analytic sample of 392 SM-AFAB ages 17-33 from a larger longitudinal study. The goals were: (1) to identify classes of SM-AFAB based on the contexts in which they drank; (2) to examine the associations between drinking contexts, minority stressors, and problematic alcohol use; and (3) to examine changes in drinking contexts over time. Using latent class analysis, we identified four classes based on drinking locations and companions (private settings, social settings, social and private settings, multiple settings). These classes did not differ in minority stress. Drinking in multiple settings was associated with more problematic alcohol use within the same timepoint and these differences were maintained six months later. However, drinking in multiple settings did not predict subsequent changes in problematic alcohol use when problematic alcohol use at the prior wave was controlled for. Based on these findings, SM-AFAB who drink in multiple settings may be an important subpopulation for interventions to target. Interventions could focus on teaching SM-AFAB strategies to limit alcohol consumption and/or minimize alcohol-related consequences.
Collapse
Affiliation(s)
- Christina Dyar
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University
| | - Brian A Feinstein
- Department of Psychology, Rosalind Franklin University of Medicine and Science
| | | | - Michael E Newcomb
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University
| | | |
Collapse
|
28
|
Martin-Storey A, Benner AD. Real and assumed sexual minority status: Longitudinal associations with depressive symptoms. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2023; 33:404-417. [PMID: 36458494 DOI: 10.1111/jora.12812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 10/06/2022] [Accepted: 10/22/2022] [Indexed: 05/25/2023]
Abstract
Sexual minority status persists in being linked to poorer adolescent mental health. Using a longitudinal sample (N = 845), we examined how youth's own same-gender attraction and their perceptions of peers' beliefs about their same-gender attraction (i.e., assumed attraction) were associated with trajectories of depressive symptoms from grade eight (when students are typically 13-14 years old) to grade 10. Reporting either same-gender attraction, assumed same-gender attraction or both were associated with higher initial levels of depressive symptoms that persisted over time compared to youth with real and assumed other-gender attraction only. These links were partially mediated by experiences of discrimination. Findings suggest the importance of understanding adolescent perceptions of peer beliefs in the association between same-gender attraction and depressive symptoms.
Collapse
Affiliation(s)
- Alexa Martin-Storey
- Département de Psychoéducation, Université de Sherbrooke, Longueuil, Quebec, Canada
| | - Aprile D Benner
- Human Development and Families Sciences & Population Research Center, University of Texas at Austin, Austin, Texas, USA
| |
Collapse
|
29
|
Wedel AV, Patterson JG, Lee DN, Stevens EM, Wagener TL, Keller-Hamilton B. E-Cigarette Use among Sexual Minoritized Women and Nonbinary People Assigned Female at Birth: Assessing the Roles of Discrimination, Perceived Stress, and Social Support. Subst Use Misuse 2023; 58:1102-1109. [PMID: 37199173 PMCID: PMC10247437 DOI: 10.1080/10826084.2023.2212056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Background: Young adult sexual minoritized women (SMW) are at disproportionate risk for e-cigarette use, which may in part be due to excess minority stress imposed by discrimination exposure. While discrimination exposure is associated with risk for combustible tobacco/nicotine use among SMW, similar associations have yet to be tested with e-cigarettes. Moreover, it is unknown if discrimination-related risk may be mitigated by protective factors such as social support. This study examined concurrent associations of discrimination, perceived stress, and social support with past 30-day e-cigarette use in a sample of young adult SMW during the COVID-19 pandemic. Methods: N = 501 SMW and nonbinary people assigned female at birth (AFAB) aged 18-30 completed an online survey. A series of logistic regressions examined associations of discrimination, perceived stress, and four forms of social support received during the COVID-19 pandemic with past-30-day e-cigarette use. Results: Among SMW, greater perceived stress (OR = 1.10, p = .03), but not discrimination exposure, was associated with e-cigarette use. Associations of discrimination with e-cigarette use were nonsignificant when most forms of social support (emotional, material/financial, and virtual) were accounted for. Associations of perceived stress with e-cigarette use were strongest among those who needed but did not receive material support. Conclusions: Perceived stress, but not discrimination exposure, was associated with risk for e-cigarette use among young SMW during the COVID-19 pandemic. Effects of nonspecific stress may be compounded by insufficient material/financial support.
Collapse
Affiliation(s)
- Amelia V. Wedel
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Joanne G. Patterson
- Division of Health Behavior and Health Promotion, The Ohio State University College of Public Health, Columbus, Ohio, USA
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Donghee N. Lee
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Elise M. Stevens
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Theodore L. Wagener
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Brittney Keller-Hamilton
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| |
Collapse
|
30
|
Botor NJB, Tuliao AP. A Scoping Review on the Role of Sexual Orientation and Gender Identity Microaggressions in Substance Use. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2023; 35:363-382. [PMID: 38601727 PMCID: PMC10903602 DOI: 10.1080/19317611.2023.2211975] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/17/2023] [Accepted: 04/26/2023] [Indexed: 04/12/2024]
Abstract
Objectives Disparities in substance use patterns and outcomes are evident among sexual and gender minority groups. Sexual orientation and gender identity (SOGI) microaggression, or the subtle forms of aggression experienced by lesbian, gay, bisexual, transgender, gender non-conforming/non-binary, and gender diverse individuals, has recently been explored as a mechanism that leads to negative adjustment outcomes, including substance use. In this study we examined extant literature on the association between SOGI microaggression and substance use, and the intermediary factors that mediate or moderate this relationship. Method Scoping review method was used to systematically map the literature base using database aggregators (e.g., Scopus, EBSCO) following the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines. Results We found that SOGI microaggression is positively associated with substance use and negative consequences, and this relationship is mediated or moderated by motivational, relational, and identity processes. Conclusion These findings suggest the need to consider microaggression experience when working with clients of diverse sexual and gender identities. Likewise, additional studies are needed on other intermediary factors and effects of microaggression on substances other than alcohol. Most importantly, this study underscores the need for understanding the link between microaggression and substance use in greater efforts to promote sexual well-being and building competence in fostering the trifecta of sexual health, sexual rights, and sexual pleasure.
Collapse
Affiliation(s)
- Nephtaly Joel B. Botor
- Center for Addiction Recovery Research, Community, Family, and Addiction Sciences Department, College of Human Sciences, Texas Tech University, Lubbock, Texas, USA
| | - Antover P. Tuliao
- Center for Addiction Recovery Research, Community, Family, and Addiction Sciences Department, College of Human Sciences, Texas Tech University, Lubbock, Texas, USA
| |
Collapse
|
31
|
Cascalheira CJ, Choi NY. Transgender Dehumanization and Mental Health: Microaggressions, Sexual Objectification, and Shame. COUNSELING PSYCHOLOGIST 2023; 51:532-559. [PMID: 37091226 PMCID: PMC10118059 DOI: 10.1177/00110000231156161] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Using structural equation modeling in a national, nonprobabilistic sample of 292 transgender women and men, this project extends the pantheoretical dehumanization framework by testing direct and indirect relations between dehumanization (i.e., a higher-order construct from experiences of transgender microaggressions and sexual objectification), internalization processes (i.e., internalized transnegativity, self-objectification), shame, and general mental health. The model explained 55% of the variance in general mental health. Direct relations between dehumanization and all internalization processes were positive and significant. Internalized transnegativity and shame were significant, negative, direct predictors of mental health, but neither dehumanization nor self-objectification was a significant direct predictor of transgender mental health. Both self-objectification and internalized transnegativity directly predicted more feelings of shame. However, only shame yielded a significant indirect pathway from dehumanization to mental health. The indirect relations from self-objectification and internalized transnegativity to mental health through shame were significant. Research, advocacy, and clinical implications are discussed.
Collapse
|
32
|
Sarno EL, Newcomb ME, Whitton SW. Minority Stress and Intimate Partner Violence among Sexual and Gender Minorities assigned Female at Birth. PSYCHOLOGY OF VIOLENCE 2023; 13:239-247. [PMID: 38045637 PMCID: PMC10691836 DOI: 10.1037/vio0000466] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Objective Sexual and gender minorities assigned female at birth (SGM-AFAB) experience high rates of intimate partner violence (IPV). Using multiwave longitudinal data, the present study tested the following associations of minority stress and IPV among SGM-AFAB: concurrent within-person (i.e., whether changes in minority stress co-occur with changes in IPV), prospective within-person (i.e., whether changes in minority stressors precede changes in IPV), and between-persons (i.e., whether individuals who experience more minority stress, on average, experience more IPV). Method Data were from Waves 1-7 (spanning 3.5 years) of a longitudinal cohort study of 488 young SGM-AFAB. At each wave, participants reported on SGM victimization, sexual orientation microaggressions, internalized heterosexism, and five types of IPV for up to three partners in the past six months. Results Controlling for other minority stress experiences, microaggressions showed concurrent within-person associations with two types of IPV victimization (psychological and coercive control) and three types of IPV perpetration (psychological, physical, and sexual), and between-persons associations with psychological IPV victimization and coercive control victimization and perpetration. Microaggressions also had a significant prospective within-persons association with SGM-specific IPV perpetration. SGM victimization showed no unique within-person associations with IPV but, between-persons, was associated with all types of IPV victimization (except coercive control), and psychological and sexual IPV perpetration. Internalized heterosexism was not associated with any IPV outcome. Conclusions Minority stress, particularly distal stressors, appear to contribute to risk for IPV among SGM-AFAB. Clinicians working with SGM-AFAB individuals in relationships may benefit from screening for experiences of minority stress.
Collapse
Affiliation(s)
- Elissa L Sarno
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University
| | - Michael E Newcomb
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University
| | | |
Collapse
|
33
|
Dyar C, Lee CM, Rhew IC, Kaysen D. Sexual minority stress and substance use: An investigation of when and under what circumstances minority stress predicts alcohol and cannabis use at the event-level. JOURNAL OF PSYCHOPATHOLOGY AND CLINICAL SCIENCE 2023; 132:475-489. [PMID: 36931822 PMCID: PMC10164110 DOI: 10.1037/abn0000819] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Sexual minority women and gender diverse (SMWGD) individuals are at elevated risk for alcohol and cannabis use disorders compared with cisgender, heterosexual women. This has been attributed to the unique stressors that SMWGD experience (i.e., sexual minority stress); however, recent studies have found mixed evidence for a link between sexual minority stress and substance use. The current manuscript introduces and tests a novel theoretical model derived from integrating minority stress theory and the multistage model of drug addiction to explain these mixed findings. We used data from a 30-day ecological momentary assessment (EMA) study of substance use among SMWGD to determine whether event-level associations between enacted stigma (bias from others) and same-/next-day alcohol and cannabis use are dependent on an individual's typical pattern of substance use (e.g., frequency, quantity, motives, and substance use disorder [SUD] symptoms). Findings indicate that enacted stigma predicted an increased likelihood of alcohol and cannabis use among those who used frequently and those who had a probable alcohol or cannabis use disorder and predicted a decreased likelihood of use among those who used less frequently. Enacted stigma also predicted cannabis (but not alcohol) use among those who reported high coping motives for use. Findings provide initial evidence in support of an integrated model of minority stress theory and the multistage model of drug addiction. Findings suggest that alcohol and cannabis use disorder interventions for SMWGD would benefit from addressing sexual minority stress and coping skill-building. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Collapse
Affiliation(s)
| | - Christine M. Lee
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Isaac C. Rhew
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Debra Kaysen
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| |
Collapse
|
34
|
Scheer JR, Lawlace M, Cascalheira CJ, Newcomb ME, Whitton SW. Help-Seeking for Severe Intimate Partner Violence Among Sexual and Gender Minority Adolescents and Young Adults Assigned Female at birth: A Latent Class Analysis. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:6723-6750. [PMID: 36472356 PMCID: PMC10050117 DOI: 10.1177/08862605221137711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Sexual and gender minority adolescents and young adults assigned female at birth (SGM-AFAB) report high rates of intimate partner violence (IPV) victimization. Despite adverse health outcomes of IPV, many survivors, particularly SGM-AFAB, do not seek help. This study (1) examined the proportion of SGM-AFAB who reported severe IPV victimization who sought help; (2) elucidated patterns of help-seeking facilitators and barriers; and (3) identified associations between sociodemographic characteristics, IPV victimization types, and minority stressors and latent classes of help-seeking facilitators and barriers. Participants included 193 SGM-AFAB (Mage = 20.6, SD = 3.4; 65.8% non-monosexual; 73.1% cisgender; 72.5% racial/ethnic minority; 16.6% annual household income $20,000 or less). Most participants who experienced severe IPV did not seek help (62.2%). Having a person or provider who was aware of the participant's abusive relationship was the most common reason for seeking help (50; 68.5%). Minimizing IPV was the most common reason for not seeking help (103; 87.3%). Fewer than 5% of SGM-AFAB who experienced severe IPV and who did not seek help reported SGM-specific help-seeking barriers, including not wanting to contribute to negative perceptions of the LGBTQ community, not disclosing their SGM status, and perceiving a lack of tailored services. Help-seeking facilitators and barriers varied by sociodemographic characteristics. Three classes of help-seeking facilitators and two classes of help-seeking barriers emerged. SGM-AFAB subgroups based on sexual and gender identity, recent coercive control, and identity as IPV victims differed in latent classes. This study's findings confirm SGM-AFAB IPV survivors' low likelihood of seeking help. Our results also underscore the importance of continuing to bolster SGM-AFAB survivors' access to trauma-informed, culturally sensitive, and affirming support. Further, multilevel prevention and intervention efforts are needed to reduce minimization of abuse and anticipatory judgment and blame among SGM-AFAB who hold multiple marginalized identities, experience coercive control, and identify as IPV victims.
Collapse
|
35
|
Lee BN, Grubbs JB. Problem gambling within sexual and gender minorities: A systematic review. Addict Behav 2023; 144:107742. [PMID: 37121088 DOI: 10.1016/j.addbeh.2023.107742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/24/2023] [Accepted: 04/20/2023] [Indexed: 05/02/2023]
Abstract
A body of literature now suggests that sexual and gender minorities (SGMs) experience a distinct set of stressors in the form of minority stress, which may function as a risk factor for the development of negative psychological and behavioral health outcomes. A systematic review of the literature was conducted through June 1st, 2022. Inclusion was limited to peer-reviewed publications in academic journals, with prospective and retrospective studies of a quantitative nature included for synthesis. Articles were required to contain an empirical measure of gambling cognitions, behaviors, motives, or outcomes. Studies that did not include sexual minorities within the sample or did not provide quantitative results which shed light on gambling in sexual minorities were excluded from the present review.In total, 12 eligible studies were identified for the current review. In general, this review highlighted methodological weaknesses within the literature and suggested that little is known about gambling in this population. Given conflicting findings across studies, further research is necessary to understand gambling in sexual and gender minorities. From a methodological standpoint, there is a need for clearer conceptualization and standardized measurement of gambling-related variables in vulnerable populations. Further, longitudinal research would be beneficial to understand the nuances of gambling disorder across sexual orientations and gender identities, as well as aid in the development of holistic intervention options that meet the needs of these more vulnerable groups.
Collapse
Affiliation(s)
- Brinna N Lee
- Department of Psychology, 822 E Merry Ave, Bowling Green State University, Bowling Green, OH 43403, USA.
| | - Joshua B Grubbs
- Department of Psychology, 822 E Merry Ave, Bowling Green State University, Bowling Green, OH 43403, USA
| |
Collapse
|
36
|
Puckett JA, Dyar C, Maroney MR, Mustanski B, Newcomb ME. Daily experiences of minority stress and mental health in transgender and gender-diverse individuals. JOURNAL OF PSYCHOPATHOLOGY AND CLINICAL SCIENCE 2023; 132:340-350. [PMID: 36913272 PMCID: PMC10159909 DOI: 10.1037/abn0000814] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Transgender and gender-diverse people experience various minority stressors although minimal research has examined prospective effects on daily affect or mental health. We explored rates of marginalization for transgender and gender-diverse participants in a daily diary study and the concurrent and prospective associations with daily affect and weekly measures of depression and anxiety symptoms, as well as the mediating effects of internalized stigma, rumination, and isolation. There were 167 participants (82.2% white; M age = 25) retained in the daily surveys. Participants completed surveys for 56 days reflecting exposure to marginalization, gender nonaffirmation, internalized stigma, rumination, isolation, affect (negative, anxious, and positive affect), and mental health (anxiety and depression symptoms). Participants experienced marginalization on 25.1% of the days. Within-person analyses revealed concurrent associations between marginalization and gender nonaffirmation with increased negative and anxious affect and increased anxiety and depression symptoms, as well as associations for gender nonaffirmation and decreased positive affect. At the within-person level, there were prospective associations between marginalization and gender nonaffirmation with increased negative affect on the next day, as well as increased anxiety and depression symptoms the next week. Concurrent analyses revealed significant indirect effects with marginalization and gender nonaffirmation associated with all three affect variables and mental health via increases in internalized stigma, rumination, and isolation. However, only gender nonaffirmation was related to isolation and affect or mental health in the prospective analyses. Clinical considerations include strategies to address the immediate effects of minority stress as well as the long-term interpersonal effects. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Collapse
Affiliation(s)
| | | | | | - Brian Mustanski
- Northwestern University Feinberg School of Medicine, Department of Medical Social Sciences
- Institute for Sexual and Gender Minority Health and Wellbeing
| | - Michael E. Newcomb
- Northwestern University Feinberg School of Medicine, Department of Medical Social Sciences
- Institute for Sexual and Gender Minority Health and Wellbeing
| |
Collapse
|
37
|
Scandurra C, Esposito C, Fantacci F, Borrello L, Bochicchio V, Giunti D, Antonelli P. Social Support, Identity Affirmation, and Psychological Well-Being: A Developmental and Intersectional Comparison between Italian Cisgender and Non-Binary People with Bisexual Orientation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3237. [PMID: 36833931 PMCID: PMC9964463 DOI: 10.3390/ijerph20043237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/10/2023] [Accepted: 02/12/2023] [Indexed: 06/18/2023]
Abstract
Incorporating the perspectives of positive psychology, intersectionality, and life course into minority stress theory, this study aimed to examine the relationships between social support, identity affirmation, and psychological well-being among 483 Italian individuals with bisexual orientation, accounting for differences in gender identity (cisgender vs. non-binary) and age groups (young, early, and middle adult). A mediation model was tested in which identity affirmation served as a presumed mediator between social support and psychological well-being. We also examined whether gender identity and age group moderated the hypothesized associations. Multivariate ANOVA and multigroup mediation analyses were conducted. Results showed that (a) cisgender individuals had higher social support and psychological well-being than non-binary individuals, but not identity affirmation, which was higher in the latter group, (b) psychological well-being, but not social support and identity affirmation, differed between groups, with the youngest cohort reporting worse health than their elders, (c) identity affirmation mediated the relationship between social support and psychological well-being, (d) mediation was significant only in binary individuals (compared to cisgender), whereas no age differences were found. Overall, this study highlights the need to consider bisexual individuals as a nonhomogeneous population living multiple life experiences, especially when minority identities intersect.
Collapse
Affiliation(s)
- Cristiano Scandurra
- Department of Neuroscience, Reproductive Sciences, and Dentistry, University of Naples Federico II, 80131 Naples, Italy
| | - Concetta Esposito
- Department of Humanistic Studies, University of Naples Federico II, 80133 Naples, Italy
| | | | - Lorenzo Borrello
- Centro Integrato di Sessuologia Clinica Il Ponte, 50136 Florence, Italy
| | - Vincenzo Bochicchio
- Department of Humanistic Studies, University of Calabria, 87036 Rende, Italy
| | - Daniel Giunti
- Centro Integrato di Sessuologia Clinica Il Ponte, 50136 Florence, Italy
| | - Paolo Antonelli
- Centro Integrato di Sessuologia Clinica Il Ponte, 50136 Florence, Italy
- Department of Health Sciences, Psychology and Psychiatry Unit, University of Florence, 50121 Florence, Italy
| |
Collapse
|
38
|
King WM, Gamarel KE, Iwamoto M, Suico S, Nemoto T, Operario D. Structural Needs, Substance Use, and Mental Health Among Transgender and Nonbinary Young Adults in the San Francisco Bay Area: Findings from the Phoenix Study. J Urban Health 2023; 100:190-203. [PMID: 36595118 PMCID: PMC9918689 DOI: 10.1007/s11524-022-00700-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 01/04/2023]
Abstract
Transgender and nonbinary (trans) young adults report high rates of substance use and adverse mental health outcomes; however, few studies have examined how social, economic, and legal factors may contribute to health inequities in this population. Guided by the structural vulnerability framework, this study sought to explore structural needs and whether these needs were associated with substance use and mental health outcomes among trans young adults. Between 2019 and 2021, 215 trans young adults aged 18-29 from San Francisco Bay Area were recruited into a longitudinal study. Baseline data were used to examine bivariate and multivariable associations between structural needs and substance use and mental health outcomes. There were bivariate differences in the number of structural needs by education, income source, incarceration history, and ethnicity, and the number of unmet structural needs was associated with education and income source. After adjusting for sociodemographics, the number of structural needs was associated with daily marijuana use (AOR 1.29, 95% CI: 1.10-1.49) and suicidal ideation (AOR 1.24, 95% CI: 1.06-1.45), and the number of unmet structural needs was associated with daily marijuana use (AOR 1.30, 95% CI: 1. 10-1.55) and depressive symptoms (β 2.00, 95% CI: 1.00-3.00). Additionally, both numbers of structural needs and unmet structural needs mediated the relationship between income source (traditional employment vs. other income only) and depressive symptoms (TIE β 2.51, 95% CI: 0.99-4.04; β 1.37, 95% CI: 0.23-2.52, respectively). Findings highlight a need for multisector efforts to address structural vulnerabilities among trans young adults.
Collapse
Affiliation(s)
- Wesley M King
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
| | - Kristi E Gamarel
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | | | | | - Don Operario
- Department of Behavioral, Social, and Health Education Sciences, Emory University, Atlanta, GA, USA
| |
Collapse
|
39
|
Batchelder AW, Foley JD, Stanton AM, Gorman KR, Morris JC, Scheer JR. Facets of Gender Expression and Discrimination in Relation to Alcohol and Other Drug Use Severity Among Sexual Minority Women and Gender Diverse Individuals Assigned Female at Birth. LGBT Health 2022; 10:191-201. [PMID: 36367714 PMCID: PMC10079249 DOI: 10.1089/lgbt.2022.0138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Sexual minority women and gender diverse individuals assigned female at birth (SMW+) consistently report more alcohol and other drug (AOD) use severity than heterosexual women, with greater disparities reported among bisexual plus (bi+) SMW (including bisexual, pansexual, queer, and those with attractions to more than one gender regardless of identity). Furthermore, emerging evidence suggests that SMW with masculine gender expression (e.g., SMW with masculine gender appearance) disproportionately experience problematic AOD use compared to those with feminine gender expression. The minority stress model, which has predominantly been investigated in relation to internalized homonegativity and sexuality-based discrimination, may also account for these AOD use disparities. This study examined gender expression, related discrimination, and AOD use severity among SMW+. Methods: In a 2020 sample of SMW+ (n = 236), we investigated AOD use severity in relation to gender expression (appearance, emotional expression, and gender roles) and gender expression-based discrimination after controlling for internalized homonegativity and sexuality-based discrimination through an online survey. Results: Masculine gender roles were associated with AOD use severity, whereas masculine appearance and emotional expression were not. In multivariable models, gender identity was inconsistently associated with alcohol use severity, sexuality-based discrimination was consistently associated with alcohol use severity and inconsistently associated with other drug use severity, and gender expression-based discrimination was associated with neither. Conclusion: This study emphasizes the importance of examining intersecting aspects of minority identity among SMW+, including facets of gender expression, in relation to AOD use severity.
Collapse
Affiliation(s)
- Abigail W. Batchelder
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Jacklyn D. Foley
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Amelia M. Stanton
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, USA
| | | | - Jenna C. Morris
- Department of Internal Medicine, University of Rochester, Rochester, New York, USA
| | - Jillian R. Scheer
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| |
Collapse
|
40
|
Dyar C, Kaysen D, Newcomb ME, Mustanski B. Event-level associations among minority stress, coping motives, and substance use among sexual minority women and gender diverse individuals. Addict Behav 2022; 134:107397. [PMID: 35700652 PMCID: PMC9732144 DOI: 10.1016/j.addbeh.2022.107397] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/27/2022] [Accepted: 06/06/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Sexual minority women and gender diverse individuals (SMWGD) are at heightened risk for alcohol and cannabis use disorders compared to heterosexual and cisgender individuals, and their heightened risk has been attributed to minority stress. However, few longitudinal studies have examined mechanisms through which minority stress may impact substance use, and none have done so at the event-level. METHODS We utilized data from a 30-day ecological momentary assessment study of 429 SMWGD who used alcohol or cannabis regularly to test a mechanistic process in which minority stress predicts alcohol and cannabis use via coping motives for use at the event-level. RESULTS When individuals experienced more enacted stigma (e.g., microaggressions) than usual during one assessment, they were more likely to use cannabis to cope during the next. In turn, occasions when cannabis was used to cope were marked by more sessions of cannabis use, longer intoxication, higher subjective intoxication, and more cannabis consequences. Indirect effects of enacted stigma on cannabis use via coping motives were significant. However, only one of internalized stigma's indirect effects was significant, with internalized stigma predicting cannabis consequences via daily coping motives. No indirect effects predicting alcohol use were significant. CONCLUSIONS Findings provide robust evidence that using to cope is a mechanism through which enacted stigma predicts cannabis use and internalized stigma predicts cannabis consequences. Results did not provide evidence for similar associations for alcohol. Our findings suggest that interventions designed to reduce cannabis use among SMWGD should attend to their minority stress experiences and cannabis use motives and teach alternative coping strategies.
Collapse
Affiliation(s)
| | - Debra Kaysen
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, USA
| | - Michael E Newcomb
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, USA; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, USA
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, USA; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, USA
| |
Collapse
|
41
|
Stauffer CS, Brown MR, Adams D, Cassity M, Sevelius J. MDMA-assisted psychotherapy; Inclusion of transgender and gender diverse people in the frontiers of PTSD treatment trials. Front Psychiatry 2022; 13:932605. [PMID: 36299539 PMCID: PMC9589439 DOI: 10.3389/fpsyt.2022.932605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Transgender and gender diverse (TGD) people experience stigma, discrimination, trauma, and post-traumatic stress disorder (PTSD) at higher rates compared to the general population; however, TGD people have been underrepresented in PTSD research. Clinical trials of 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy demonstrate promising safety and efficacy for the treatment of PTSD. Issues related to equitable access, power imbalances in the therapeutic relationship, and vulnerable states of consciousness occasioned by MDMA are magnified when working with people affected by structural vulnerabilities and health disparities, and community engagement in research planning and implementation is essential. To inform the inclusion and safety of TGD people in future MDMA-assisted psychotherapy research, the aims of the current study were to: characterize TGD experiences with trauma-related mental health care, assess openness of TGD people to participate in experimental PTSD research, and to gather specific feedback on protocol design for conducting MDMA-assisted psychotherapy with TGD people. Materials and methods We conducted three virtual focus group discussions (FGDs) with 5-6 participants each (N = 17). Eligible TGD participants had a history of receiving trauma-related mental health care. Each FGD was facilitated by two licensed clinicians who identified as TGD. Qualitative data analysis was conducted via an iterative process of identification of recurrent patterns and themes. Results We have identified several key issues TGD people face when seeking and engaging in trauma-related mental health care, including barriers to receiving adequate gender-affirming and trauma-informed mental health care and frustration with providers lacking cultural humility. Suggested amendments to MDMA-assisted psychotherapy protocols include: routine collection of trans-inclusive gender identity data, implementing an explicit gender-affirming treatment approach, ensuring a culturally safe setting, and diversifying co-therapy dyads. Discussion The inclusion of TGD voices in early conversations about emerging experimental PTSD interventions promotes equitable access, in the context of health and healthcare disparities, and helps researchers understand the needs of the community and tailor research to meet those needs. Through an ongoing conversation with the TGD community, we aim to incorporate a gender-affirming approach into existing research protocols and inform future applications of MDMA-assisted psychotherapy in addressing the effects of minority stress and boosting resilience.
Collapse
Affiliation(s)
- Christopher S Stauffer
- Social Neuroscience and Psychotherapy Lab, Oregon Health and Science Institute, Department of Psychiatry, Portland, OR, United States
- Portland VA Health Care System, Department of Mental Health, Portland, OR, United States
| | - Melanie R Brown
- School of Public Health, Oregon Health and Science University-Portland State University, Portland, OR, United States
| | - Dee Adams
- Center for Public Health and Human Rights, Department of Epidemiology, John Hopkins University, Baltimore, MD, United States
| | - Marca Cassity
- Social Neuroscience and Psychotherapy Lab, Oregon Health and Science Institute, Department of Psychiatry, Portland, OR, United States
- Portland VA Health Care System, Department of Mental Health, Portland, OR, United States
| | - Jae Sevelius
- Center of Excellence for Transgender Health, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| |
Collapse
|
42
|
Sarno EL, Dyar C, Newcomb ME, Whitton SW. Relationship quality and mental health among sexual and gender minorities. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2022; 36:770-779. [PMID: 34914423 PMCID: PMC9200904 DOI: 10.1037/fam0000944] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Sexual and gender minorities assigned female at birth (i.e., sexual minority women, transgender men, and gender diverse [SMW TGD] individuals) experience disproportionately high rates of anxiety, depression, and substance use problems. Romantic relationship involvement has been shown to be beneficial to mental health and substance use among sexual and gender minorities. However, few studies have explored the impact of relationship quality on mental health, or if high relationship quality can reduce the negative impact of minority stress on well-being in this population. The present study examined within-persons associations of romantic relationship quality with symptoms of anxiety and depression, and alcohol and cannabis use problems among SMW TGD individuals in romantic relationships, and tested relationship quality as a moderator of associations of minority stress with mental health and substance use. Participants were 213 SMW TGD individuals (mean age: 20.63; 70.9% cisgender women, 7.5% transgender men, and 19.2% gender diverse). Within-persons, higher relationship quality was associated with better mental health and substance use outcomes. Relationship quality at the between-persons level moderated the within-persons association of internalized heterosexism with depression, and of microaggressions with cannabis use problems. No other interaction effects were significant. The within-persons associations found in this study lend important support to relationship interventions based on theories that improvements in romantic relationship quality will result in improved well-being over time. Results can inform relationship education interventions to reduce mental health and substance use disparities in SMW TGD communities. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
Collapse
|
43
|
Expanded Conceptual Framework for Ethical Action by Nurses on the “Further Upstream and Farther Downstream” Determinants of Health Equity. J Addict Nurs 2022; 33:203-214. [DOI: 10.1097/jan.0000000000000484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
44
|
Dyar C, Kaysen D. Multiple diverse drinking trajectories among sexual minority women: Unique and joint prediction by minority stress and social influence risk factors. Addict Behav 2022; 129:107273. [PMID: 35219035 DOI: 10.1016/j.addbeh.2022.107273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/28/2022] [Accepted: 01/31/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Sexual minority populations are at heightened risk for alcohol use disorders compared to heterosexual populations, and these disparities are particularly pronounced for sexual minority women (SMW). Little research has examined the diversity of drinking trajectories among sexual minorities, despite evidence that such trajectories have high predictive utility and are useful in understanding how risk factors may be uniquely associated with specific trajectories. METHOD We utilized four waves of data (12 months between waves) from a sample of 1,057 SMW ages 18-25 at Wave 1. The goals were to (a) identify multiple distinct trajectories of alcohol use; (b) examine the predictive utility of these trajectories; and (c) test associations between minority stress (e.g., discrimination) and social influence (e.g., sexual minority community involvement) risk factors and alcohol trajectories. RESULTS Using growth mixture modeling, we identified five classes based on drinking patterns at Wave 1 and change over time (stable low, stable high drinking, stable high HED, low increasing, and high decreasing). These classes were differentially associated with Wave 1 levels and changes in alcohol consequences. Minority stressors uniquely predicted a low increasing trajectory, while social influences uniquely predicted a stable high trajectory. Both minority stress and social risk factors predicted high decreasing and stable high HED trajectories. CONCLUSIONS Findings indicate that some drinking trajectories among SMW appear similar to those found in the general population, while others appear unique. Results provide insight into how minority stress and social influence risk factors may uniquely and jointly contribute to disparities affecting this population.
Collapse
Affiliation(s)
- Christina Dyar
- College of Nursing, The Ohio State University, United States.
| | - Debra Kaysen
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, United States
| |
Collapse
|
45
|
Adams LM, Miller AB. Mechanisms of Mental-Health Disparities Among Minoritized Groups: How Well Are the Top Journals in Clinical Psychology Representing This Work? Clin Psychol Sci 2022; 10:387-416. [PMID: 35602543 PMCID: PMC9122282 DOI: 10.1177/21677026211026979] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
We have known for decades that mental health disparities exist among minoritized groups, including race, ethnicity, sexual identities, gender identity and expression, ability, and others. Theories and frameworks that incorporate stressors unique to the experiences of minoritized groups, such as the biopsychosocial model of racism (Clark et al, 1999) and minority stress model (Meyer, 2003), offer testable mechanisms that may help explain, in part, mental health disparities. However, research addressing mechanisms of these disparities is still scarce and is not well represented in our top clinical psychology journals. This review critically examines the extent to which top tier clinical psychology journals publish work examining mechanisms of mental health disparities among minoritized populations. We find very few studies have been published in top clinical psychology journals that address mechanisms of mental health disparities. We examine potential reasons for this and discuss recommendations for future research.
Collapse
|
46
|
Elmer EM, van Tilburg T, Fokkema T. Minority Stress and Loneliness in a Global Sample of Sexual Minority Adults: The Roles of Social Anxiety, Social Inhibition, and Community Involvement. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:2269-2298. [PMID: 35084615 PMCID: PMC9192366 DOI: 10.1007/s10508-021-02132-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 06/29/2021] [Accepted: 08/12/2021] [Indexed: 06/14/2023]
Abstract
Research suggests that loneliness among sexual minority adults is associated with marginalization, but it is unclear which processes may underlie this relationship. This cross-sectional study examined five possibilities: stigma preoccupation, internalized homonegativity, sexual orientation concealment, social anxiety, and social inhibition. The study also examined the possible protective role of LGBTQ community involvement. Respondents were 7856 sexual minority adults aged 18-88 years from 85 countries who completed an online survey. Results of structural equation modeling indicated that marginalization was positively associated with both social and emotional loneliness, and that part of this relationship was indirect via proximal minority stress factors (especially stigma preoccupation) and, in turn, social anxiety and social inhibition. Moreover, while LGBTQ community involvement was associated with greater marginalization, it was also associated with lower levels of proximal stress and both forms of loneliness. Among those who were more involved in the LGBTQ community, the associations between marginalization and proximal stress were somewhat weaker, as were those between stigma preoccupation and social anxiety, and between social inhibition and social loneliness. In contrast, the associations between concealment and social anxiety were somewhat stronger. Model fit and patterns of association were similar after controlling for the possible confounding effect of dispositional negative affectivity, but several coefficients were lower. Findings underscore the continuing need to counter marginalization of sexual minorities, both outside and within the LGBTQ community, and suggest possible avenues for alleviating loneliness at the individual level, such as cognitive-behavioral interventions targeting stigma preoccupation and social anxiety.
Collapse
Affiliation(s)
- Eddy M Elmer
- Department of Sociology, Vrije Universiteit Amsterdam, De Boelelaan 1105, 1081 HV, Amsterdam, Netherlands.
| | - Theo van Tilburg
- Department of Sociology, Vrije Universiteit Amsterdam, De Boelelaan 1105, 1081 HV, Amsterdam, Netherlands
| | - Tineke Fokkema
- Netherlands Interdisciplinary Demographic Institute, KNAW/University of Groningen, The Hague, Netherlands
- Department of Public Administration and Sociology, Erasmus University Rotterdam, Rotterdam, Netherlands
| |
Collapse
|
47
|
Schipani-McLaughlin AM, Nielsen KE, Mosley EA, Leone RM, Oesterle DW, Orchowski LM, Davis KC, Gilmore AK. Alcohol use and alcohol-related consequences based on gender and sexual orientation among college students. Am J Addict 2022; 31:189-199. [PMID: 35385599 PMCID: PMC9117501 DOI: 10.1111/ajad.13283] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 03/10/2022] [Accepted: 03/13/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Research has not yet investigated how the association between alcohol and alcohol-related consequences differs across cisgender heterosexual women (CHW), cisgender heterosexual men (CHM), and sexual and gender minority (SGM) college students. METHODS Participants were N = 754 college students (34.5% CHW [n = 260]; 34.5% CHM [n = 260]; 31.0% SGM [n = 234]) between the ages 18 and 25 who completed a survey on sexual orientation, gender identity, alcohol use (i.e., average drinks per week), and alcohol-related consequences. RESULTS Among individuals who reported alcohol use, CHM reported significantly more drinks per week compared to CHW and SGM. The logistic model of a zero-inflated negative binomial regression indicated that excess zeros in the alcohol-related consequences were more likely among (1) nondrinkers and (2) SGM compared to CHM. The count portion of the model indicated that, among drinkers, there was a positive association between drinks per week and alcohol-related consequences. Estimated alcohol-related consequences per drink were 1.90% higher among CHW than CHM and 2.76% higher among SGM than CHM. Exploratory analyses did not find significant differences in outcomes between cisgender female and male sexual minority students. DISCUSSION AND CONCLUSION Findings suggest that although CHW and SGM students consume less alcohol than CHM, these students experience more alcohol-related consequences per drink. SCIENTIFIC SIGNIFICANCE This study advances the field's knowledge of alcohol use patterns and consequences among SGM college students. There is a need for alcohol education programming that is tailored to the unique experiences, identities, and minority stressors of SGM college students.
Collapse
Affiliation(s)
- Anne Marie Schipani-McLaughlin
- Department of Health Policy and Behavioral Sciences, Georgia State University, Atlanta, Georgia, USA.,Center for Research on Interpersonal Violence, Georgia State University, Atlanta, Georgia, USA
| | - Karen E Nielsen
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Elizabeth A Mosley
- Department of Health Policy and Behavioral Sciences, Georgia State University, Atlanta, Georgia, USA.,Center for Research on Interpersonal Violence, Georgia State University, Atlanta, Georgia, USA.,Mark Chaffin Center for Healthy Development, School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Ruschelle M Leone
- Department of Health Policy and Behavioral Sciences, Georgia State University, Atlanta, Georgia, USA.,Center for Research on Interpersonal Violence, Georgia State University, Atlanta, Georgia, USA.,Mark Chaffin Center for Healthy Development, School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Daniel W Oesterle
- Department of Psychological Sciences, Purdue University, West Lafayette, Illinois, USA
| | - Lindsay M Orchowski
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | | | - Amanda K Gilmore
- Department of Health Policy and Behavioral Sciences, Georgia State University, Atlanta, Georgia, USA.,Center for Research on Interpersonal Violence, Georgia State University, Atlanta, Georgia, USA.,Mark Chaffin Center for Healthy Development, School of Public Health, Georgia State University, Atlanta, Georgia, USA
| |
Collapse
|
48
|
Porche MV, Fortuna LR, Tolou-Shams M. Unpacking the Layers: Dismantling Inequities in Substance Use Services and Outcomes for Racially Minoritized Adolescents. Child Adolesc Psychiatr Clin N Am 2022; 31:223-236. [PMID: 35361361 PMCID: PMC10662943 DOI: 10.1016/j.chc.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Minoritized youth have lower prevalence rates of substance use disorders (SUD) compared with White peers, but proportionally those that are diagnosed are less likely to engage in specialized care and there are few culturally responsive treatments or programs available. We examine social determinants of SUD, with emphasis on the impact of trauma, including racial trauma, and include an intersectional approach incorporating race, ethnicity, and gender. This review of the literature highlights evidence-based effective clinical practice as examples for the field in developing therapeutic approaches to SUD for this population.
Collapse
Affiliation(s)
- Michelle V Porche
- Department of Psychiatry and Behavioral Sciences, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco (UCSF), 1001 Potrero Avenue, Building 5, Room 7M, San Francisco, CA, USA.
| | - Lisa R Fortuna
- Department of Psychiatry and Behavioral Sciences, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, 1001 Potrero Avenue, Building 5, Room 7M16, San Francisco, CA, USA
| | - Marina Tolou-Shams
- Department of Psychiatry and Behavioral Sciences, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, 1001 Potrero Avenue, Building 5, Room 7M18, San Francisco, CA 94110, USA
| |
Collapse
|
49
|
Shi J, Dewaele A, Lai W, Lin Z, Chen X, Li Q, Wang H, Guo L, Lu C, Zhang W. Gender differences in the association of sexual orientation with depressive symptoms: A national cross-sectional study among Chinese college students. J Affect Disord 2022; 302:1-6. [PMID: 35065090 DOI: 10.1016/j.jad.2022.01.072] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/16/2022] [Accepted: 01/18/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Depressive symptoms among the lesbian, gay, bisexual (LGB) in college students have generated worldwide concern in recent decades. This study aimed to estimate the associations between sexual orientation and depressive symptoms among Chinese college students, with a focus on gender differences. METHODS A total of 30,733 college students were recruited from 10 Chinese province-level regions with a multistage, stratified cluster, random sampling method between March and June 2019. The 20-item Center for Epidemiologic Studies Depression Scale (CESD-20) was used to measure the depressive symptoms. Sexual orientation was assessed by asking the question, "Which of the following options best describes you?" The responses were categorized as heterosexual, gay/lesbian, bisexual, and unsure. RESULTS In our sample (N = 30,733), the prevalence of depressive symptoms was 6.1%. Among the surveyed Chinese college students, 3.7% self-reported as LGB, and 7.2% were unsure. LGB (gay/lesbian: 14.9% for males and 6.8% for females; bisexual: 9.3% for males and 16.4% for females) had a higher risk of depressive symptoms than heterosexuals. After adjusting for control variables, LGB and unsure college students were more likely to have depressive symptoms than their heterosexual peers. For males, unsure college students reported the highest risk of depressive symptoms; for females, lesbian and bisexual college students reported the highest risk of depressive symptoms. LIMITATIONS The cross-sectional study design and self-reported depressive symptoms and sexual orientation. CONCLUSION LGB was associated with increased depressive symptoms among Chinese college students. Furthermore, the associations of LGB sexual orientation with depressive symptoms were more robust for females than males.
Collapse
Affiliation(s)
- Jingman Shi
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou 510080, China
| | - Alexis Dewaele
- Faculty of Psychology and Educational Sciences, Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Wenjian Lai
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou 510080, China
| | - Ziyi Lin
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou 510080, China
| | - Xiaoliang Chen
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou 510080, China
| | - Qian Li
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou 510080, China
| | - Hongqiong Wang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou 510080, China
| | - Lan Guo
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou 510080, China.
| | - Ciyong Lu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou 510080, China
| | - Weihong Zhang
- Faculty of Psychology and Educational Sciences, Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| |
Collapse
|
50
|
Differences by sex and gender in the association between minority stress and alcohol use among sexual and gender minority youth: A daily diary study. Soc Sci Med 2021; 294:114679. [PMID: 35030397 PMCID: PMC7612808 DOI: 10.1016/j.socscimed.2021.114679] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 06/23/2021] [Accepted: 12/21/2021] [Indexed: 12/12/2022]
Abstract
Rationale Sexual and gender minority (SGM) youth consume more alcohol than their heterosexual, cisgender peers. The experience of minority stress is theorized to explain these disparities. Research often neglects the day-to-day variability in minority stress that SGM youth encounter and whether alcohol use is associated with daily experiences of minority stress. Further, there is heterogeneity in alcohol use among SGM youth. Sex assigned at birth and gender identity could potentially explain this heterogeneity. Objective Therefore, this study aimed to examine whether daily experiences of minority stress were associated with daily alcohol use among SGM youth and how these associations differed by sex assigned at birth and gender identity. Methods A 14-day daily diary study was conducted among 393 Dutch SGM youth (M age = 18.36 SD = 2.65). Results Results showed few significant associations between both mean levels of minority stress and daily experiences with minority stress with alcohol use. However, higher mean levels of prejudice events were associated with higher odds of daily alcohol use (OR = 7.01, 95% CI: 1.20–40.89). Daily experiences with identity concealment were associated with lower odds of daily alcohol use for males (OR = 0.72, 95% CI: 0.60–0.86), but not for females (OR = 1.11, 95% CI: 0.93–1.32). Further, for cisgender youth, daily experiences with prejudice events were associated with higher odds of alcohol use (OR = 1.99, 95% CI: 1.05–3.78), but this was not the case for gender minority youth (OR = 0.42, 95% CI: 0.15–1.18). Conclusions The findings showed few significant associations between minority stressors and alcohol use, but daily experiences of concealment and prejudice events were associated with daily alcohol use and these associations varied by sex assigned at birth and gender identity, respectively.
Collapse
|